不同时期颈椎减压手术治疗不完全性颈脊髓损伤的疗效比较  

Comparison of the efficacy of cervical decompression performed at different times in the treatment of incomplete cervical spinal cord injury

作　　者：李帅[1,2] 贺园[3] 高延征 蒋电明[5] 舒均 陈建[7] 都金鹏 朱雷 黄云飞[2] 昌震 闫亮[2] 惠华[2] 杨小彬[2] 孔令擘[2] 贺宝荣 Li Shuai;He Yuan;Gao Yanzheng;Jiang Dianming;Shu Jun;Chen Jian;Du Jinpeng;Zhu Lei;Huang Yunfei;Chang Zhen;Yan Liang;Hui Hua;Yang Xiaobin;Kong Lingbo;He Baorong(Medical College,Yan′an University,Yan′an 716099,China;Department of Spine Surgery,Honghui Hospital,Xi′an Jiaotong University,Xi′an 710054,China;Department of Orthopedics,Xi′an Fifth Hospital,Xi′an 710082,China;Department of Spinal and Spinal Cord Surgery,Henan People′s Hospital,Henan University,Zhengzhou 450003,China;Department of Spine Surgery,Third Affiliated Hospital of Chongqing Medical University,Chongqing 401120,China;Department of Spine Surgery,Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China;Department of Spine Surgery,Yinchuan Guolong Hospital,Yinchuan 750001,China)

机构地区：[1]延安大学医学院,延安716099 [2]西安交通大学附属红会医院脊柱外科,西安710054 [3]西安市第五医院骨科,西安710082 [4]河南省人民医院脊柱脊髓外科,郑州450003 [5]重庆医科大学附属第三医院脊柱外科,重庆401120 [6]昆明医科大学第二附属医院脊柱外科,昆明650101 [7]银川国龙医院脊柱外科,银川750001

出　　处：《中华创伤杂志》2023年第12期1070-1078,共9页Chinese Journal of Trauma

基　　金：陕西省重点研发计划(2023JH-YXYB-0145)。

摘　　要：目的比较不同时期颈椎减压手术治疗不完全性颈脊髓损伤的疗效。方法采用多中心回顾性队列研究分析2018年5月至2021年5月西安交通大学附属红会医院等6家医院收治的96例不完全性颈脊髓损伤患者的临床资料,其中男60例,女36例;年龄28~42岁[(35.2±6.7)岁]。损伤节段:C37例,C415例,C520例,C623例,C731例。美国脊髓损伤协会(ASIA)分级:B级59例,C级27例,D级10例。36例伤后24 h内行颈椎减压手术(早期组),33例伤后24~72 h行颈椎减压手术(晚期组),27例伤后4~14 d内行颈椎减压手术(延迟组)。比较三组手术时间、术中出血量、术后引流量、住院时间;术前及术后3 d Cobb角、椎间隙高度、椎管占位;术前,术后3个月、1年及末次随访时ASIA分级、ASIA运动评分、ASIA轻触觉评分、ASIA针刺觉评分、视觉模拟评分(VAS)、日本骨科学会(JOA)评分、颈部功能障碍指数(NDI);并发症发生率。结果患者均获随访12~21个月[(16.4±4.2)个月]。三组手术时间差异无统计学意义(P均>0.05)。早期组术中出血量和术后引流量分别为(312.5±5.2)ml、(165.3±45.8)ml,多于晚期组的(253.5±40.0)ml、(120.4±60.6)ml和延迟组的(267.3±36.8)ml、(130.4±38.6)ml(P均<0.01);晚期组和延迟组差异无统计学意义(P均>0.05)。早期组住院时间为(5.2±1.6)d,短于晚期组的(7.6±2.3)d和延迟组的(8.0±1.3)d(P均<0.05);晚期组和延迟组差异无统计学意义(P>0.05)。三组术前及术后3 d Cobb角、椎间隙高度、椎管占位差异无统计学意义(P均>0.05)。三组术前ASIA分级,ASIA运动评分、轻触觉评分、针刺觉评分,VAS、JOA评分、NDI差异无统计学意义(P均>0.05)。早期组术后3个月、1年及末次随访时ASIA分级优于晚期组和延迟组(P<0.05或0.01),晚期组和延迟组差异无统计学意义(P均>0.05)。早期组术后3个月、1年及末次随访时ASIA运动评分分别为(56.4±4.5)分、(76.3±3.6)分、(85.4±6.5)分,高于晚期组的(52.3±2.4)Objective To compare the efficacy of cervical decompression performed at different times in the treatment of incomplete cervical spinal cord injury.Methods A multicenter retrospective cohort study was conducted to analyze the clinical data of 96 patients with incomplete cervical spinal cord injury admitted to six hospitals including Honghui Hospital affiliated to Xi'an Jiaotong University,etc,from May 2018 to May 2021.There were 36 females and 60 males,aged 28-42 years[(35.2±6.7)years].The injured segments were at C3 in 7 patients,C4 in 15,C5 in 20,C6 in 23 and C7 in 31.According to the American Spinal Injury Association(ASIA)scale,there were 59 patients with grade B,27 grade C,and 10 grade D.A total of 36 patients underwent cervical decompression within 24 hours after injury(early group),33 patients within 24-72 hours after injury(late group),and 27 patients within 4-14 days after injury(delayed group).The operation time,intraoperative blood loss,postoperative drainage,length of hospital stay,Cobb angle,height of intervertebral space and space occupation of the spinal canal before surgery and at postoperative 3 days,and ASIA score,ASIA motor score,ASIA light tactile score,ASIA acupuncture sensation score,visual analog scale(VAS)score,Japanese Orthopedic Association(JOA)score,neck dysfunction index(NDI)before surgery and at postoperative 3 months,1 year and at the last follow-up and incidence of complications were compared among the three groups.Results All the patients were followed up for 12-21 months[(16.4±4.2)months].There was no significant difference in the operation time among the three groups(all P>0.05).The intraoperative blood loss and postoperative drainage volume in the early group were(312.5±5.2)ml and(165.3±45.8)ml,which were higher than those in the late group[(253.5±40.0)ml,(120.4±60.6)ml]and the delayed group[(267.3±36.8)ml and(130.4±38.6)ml](all P<0.01).There was no significant difference between the late group and the delayed group(all P>0.05).The length of hospital stay in the early gr

关 键 词：颈椎 脊髓损伤 减压术 外科 手术时机 

分 类 号：R651.2[医药卫生—外科学]