摘要
目的探讨无骨折脱位型颈脊髓损伤的手术治疗及效果。方法回顾分析深圳市光明新区光明医院2003年10月至2008年6月收治28例无骨折脱位型颈脊髓损伤患者,依据影像学表现、致伤特点及病理基础采用3种手术方式:颈前路椎间盘摘除减压cage植入钢板内固定术7例。全椎板切除减压颈椎后路钉棒系统内固定辅以侧块间植骨融合术12例。颈前路椎体次全切除减压钛网植入钢板内固定术9例,术后根据不同情况进行对症及康复治疗。结果所有病例术中均未发生血管、神经损伤等并发症,28例均得到随访,随访时间6～38个月(平均18.5个月)。术后按Frankel分级标准及计算JOA改善率进行评定。其中1例A级患者术后到C级;16例B级患者,术后4例达C级,10例达D级,2例达E级;9例C级患者,术后4例达D级,5例达E级;2例D级患者,1例达E级,1例稍改善。术后JOA评分较术前平均增加7.34分,术后JOA评分改善率为68.9%。结论无骨折脱位型急性颈脊髓损伤应早期手术治疗,根据病理基础及受伤机理采取合理手术方式,可以获得良好的临床疗效。
Objective To investigate the surgical treatment and effect about non-fracture and dislocation of the cervical spinal cord injury patients. Methods Retrospective analysis of Guangming new district hospital in October 2003 -2008 year in June without fracture and dislocation treated 28 cases of cervical spinal cord injury patients, based on imaging performance, injury characteristics and the pathological basis of using three kinds of operation methods： anterior cervical disc between cone cage implant removal decompression plate fixation in 7 cases. Posterior cervical laminectomy decompression screw-rod fixation supplemented with lateral mass of interbody fusion in 12 cases. Anterior cervical decompression and subtotal cone implant titanium mesh plate fixation in 9 cases, depending on the situation after symptomatic treatment and rehabilitation. Results All patients were not blood vessel surgery, nerve damage and other complications, 28 cases were followed up for 6 to 38 months （mean 18.5 months）. Surgery according to Frankel grading standards and calculation of JOA improvement rate to be assessed. 1 case of postoperative A-to C level; 16 cases of B-class patients, after four cases of up to C grade, 10 cases of up to D level, two cases of up to E grade; nine cases of C-class patients, after four cases of up to D level, five cases of up to E grade; two cases of D-class patients, 1 case up to E grade, 1 patient improved slightly. Postoperative JOA score than the average increase of 7.34 points before surgery, postoperative JOA score improvement rate was 68.9%. Conclusion Non-fracture and dislocation of acute cervical spinal cord injury should be the early surgical treatment, according to the pathological basis and the injury mechanism take reasonable surgical method can obtain a good clinical effect.
出处
《中国医药指南》
2010年第6期15-17,共3页
Guide of China Medicine
关键词
颈椎
脊髓损伤
无骨折脱位
Cervical spine
Spinal cord injury
Without fracture or dislocation
