摘要
[目的]探讨急性颈椎间盘损伤合并脊髓损伤的临床特点、损伤机制、手术方法和预后。[方法]临床资料回顾性分析,2000～2008年收治急性颈椎间盘损伤合并脊髓损伤患者25例,伤后X线平片均显示无骨折脱位,MRI均有不同程度的颈椎间盘损伤和脊髓损伤异常信号。颈椎屈曲型损伤16例。按美国脊髓损伤学会脊髓神经功能分级(ASIA标准):A级1例,B级9例,C级12例,D级3例。23例行颈前路间盘切除减压与固定手术,2例合并椎管狭窄者行前后路联合手术。早期介入康复治疗。术前、后ASIA运动评分和日常生活动作能力评分,评价神经功能,动力位X线片评价颈椎稳定性,MRI评价脊髓状况。[结果]颈椎屈曲型损伤占64%,术前颈椎生理前凸减小占84%。随访平均38个月。植骨全部融合,动力位X线片测量均显示颈椎稳定性良好。伤后1周内MRI表现单纯脊髓水肿者85%获得提高1～2个级别的恢复;髓内出血信号长度<4mm者60%获得提高1个级别的恢复;髓内出血信号长度>4mm者2例均无恢复。平均ASIA运动评分由45.52±16.05增至85.74±9.36,日常生活动作能力评分由36.32±11.47增至82.54±9.81,差异有统计学意义(P<0.05)。[结论]急性颈椎间盘损伤是无骨折脱位型脊髓损伤的原因之一,颈椎损伤多为屈曲型,颈椎生理曲度减小是损伤前置因素,脊髓损伤多为不完全性,预后相对较好。颈前路减压与固定手术可为脊髓损伤修复创造有利条件。
[ Objective] To analyze the clinical characteristics, mechanism , prognosis and surgical treatment of acute cervical disc injury with spinal cord injury. [ Methods] Twenty -five patients with acute cervical disc injury and spinal cord injury were retrospectively reviewed. Plain X - rays showed no fracture or dislocation. MRI showed cervical discs injury and spinal cord injury signals. Sixteen cases showed flexion injury. Neurological function according to the ASIA classification： A 1 cases, B 9 cases, C 12 cases and D 3 cases. Twenty - three cases underwent anterior approach discectomy and bone graft and internal fixation. Two cases of spinal stenosis underwent anterior and posterior approach procedure. All 25 cases of spinal cord injury received early rehabilitation and were evaluated with X -rays, MRI, ASIA scores and ADL scores. [ Results] Flexion injury of cervical spine was in 64%. Lordosis of cervical spine was decreased in 84% before operation. All 25 cases were evaluated clinically, radiographically, and functionally during the follow -up （mean, 38 months） . No loosening or breakage was found, and the grafted bone was completely fused. Dynamic X - rays showed good cervical stability. 75% of patiants with edema of spinal cord increased 1 -2 grades according to ASIA, 67% of patiants with hemorrhage less than 4 mm in spinal cord increased by 1 grade, and one case of hemorrhage more than 4 mm in spinal cord was not improved. ASIA motor scores increased from 45.52 ±16. 05 to 85.74± 9. 36. ADL scores increased from 36. 32 ±11.47 to 82.54±9.81. The difference showed statistical significance （ P 〈 0. 05 ）. [ Conclusion ] The acute cervical disc injury is one of causes of spinal cord injury without fracture and dislocation. Most of the cases are flexion cervical injury. Decreased lordosis of cervical spine is fore - lying factor of injury.Most spinal cord injuries are incomplete. Prognosis of the spinal cord injury is better. Anterior cervical decompression and fusion can create an advantageous environment for spinal cord injury recovery.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2010年第15期1262-1265,共4页
Orthopedic Journal of China
基金
首都医学发展科研基金资助(编号:2007-3131)
北京市科技新星计划(编号:2007B070)
关键词
颈椎间盘
脊髓损伤
无骨折脱位
治疗
cervical disc, spinal cord injury, dislocation without fracture, treatment
