摘要
目的 探讨伴有椎管狭窄的颈脊髓损伤的手术治疗。 方法 １９９５ 年１ 月～１９９８ 年４月采用扩大半椎板切除减压术治疗颈脊髓损伤５１ 例，其中无骨折脱位者３９ 例，下颈椎骨折脱位１１例，爆裂骨折１ 例；中央脊髓损伤１８ 例，不全脊髓损伤１９ 例，完全脊髓损伤１４ 例。２３ 例行ＭＲＩ检查显示，１４ 例有颈椎退变，３ 例Ｔ２ 多节段高信号，３ 例Ｔ１ 脊髓内有囊腔，２ 例有一段脊髓软化坏死，１ 例脊髓断裂。伤后２４ 小时以内手术３ 例，４８ 小时以内９ 例，１ 周以内２ 例，１ 周以上３５ 例，１～２ 年２ 例。手术方法：选症状较重一侧，局麻下行扩大半椎板切除术（ 向外至关节突内侧，中线棘突根椎板斜行切除，显出硬膜宽度的３／５～２／３），其中Ｃ３ ～Ｃ７ 切除４２ 例，Ｃ３ ～Ｔ１３ 例，Ｃ２～Ｃ７２ 例，Ｃ３ ～Ｃ６ ３ 例，Ｃ４ ～Ｃ７３例。 结果 ５１ 例患者均获随访，平均随访时间１ 年７ 个月。脊髓完全损伤者上肢肱桡肌、桡腕长伸肌恢复者６ 例，下肢均无恢复；中央脊髓损伤者上下肢肌肉包括手内在肌恢复者１２ 例，手内在肌未恢复者５ 例，均系２ 周以上手术者；脊髓不完全损伤者１７ 例有明显恢复（Ｆｒａｎｋｅｌ Ⅳ级），３ 例未恢复。 结论 扩大半椎板切除?
Objective To treat cervical spinal cord injury (SCI) accompanied with narrowing spinal canal by expanded hemilaminectomy. Methods From 1995 Jan uary to 1998 April 51 patints of cervical SCI were treated by expanded hemilaminectomy. Spinal injury classificed in to 3 types:no fracture dislocation (39 patints) fracturedislocation at the lower cervical spine (11),and burst fracture (1). The types of SCI incladed central cord injury (18 patints) incomplete cord injury (19), and complete cord injury (14). MR imaging in 23 patints showed degenerative changes with normal intensity of the cord in 14 patints, multiple level hyperintensity in 3,cystic changes in 3,myelomalasia in 3, and cord brocken in 1. Expanded hemilaminectomy was performed in 24 hours in 3 patints,in 48 hours in 9,in one week in 2,after one week in 35, and after one year in 2. The left or right laminae were removed from C 7 to C 3 in 42 patints, C 3～T 1 in 3,C 2～C 7 in 2, C 3～C 6 in 3 and C 4～C 7 in 3. Hemilaminectomy was expanded lateral to the inner of apophyseal joint and medial to the inner lamina beneath the spinal process. Results Follow up lasted for 1 year and 7 months. Six patints with complete cord injury had of the no recovery lower extremity but recovery of the brachialis and extensor radial longus. 12 patints of central cord injury had full recovery except intrinsic muscles of the hand (5). They operated were on 2 weeks after injury.17 patints of incomplete cord injury recovered to Frankel Ⅳ. Conclusions Expanded hemilaminectomy is indicated for patints of cervical SCI with narrowing spinal canal or without fracture dislocation. Best results can be obtained in patints of centralcord injury, and incomplete cord injury. Even in complete cord injury, 1～2 forearm muscle may recover (24.8%), securing a pinch grip reconstruction.
出处
《中华外科杂志》
CAS
CSCD
北大核心
1999年第10期607-609,I037,共4页
Chinese Journal of Surgery
关键词
脊髓损伤
椎板切除术
椎管狭窄
Spinal cord injuries Laminectomy Spinal stenosis Spinal cord compression
