无骨折脱位颈脊髓损伤的手术治疗.DOCVIP

临床医学论文-无骨折脱位颈脊髓损伤的手术治疗 ?????????????????????????? 作者：赵兵 崔易坤 陈利江 尹振宇 【摘要】? 目的 探讨无骨折脱位型颈脊髓损伤的手术策略及治疗效果。方法 根据影像学表现的不同，对26例无骨折脱位型颈脊髓损伤患者分别采用前路减压植骨融合内固定或后路单开门椎管扩大成形术，术前、术后采用Frankel分级和JOA17分法评价临床疗效。结果 术后Frankel分级较术前明显改善。术前JOA评分为(5.3±2.5)分,术后随访末次JOA评分为( 12.2±3.7)分,改善率为59 %，有统计学意义( P0. 01)。结论 对无骨折脱位型颈脊髓损伤, 根据患者的不同特点, 有针对性地选择手术方式, 可以获得较好的临床结果。 【关键词】? 颈椎; 无骨折脱位; 脊髓损伤; 手术 ??? 【Abstract】? Objective To evaluate the surgical treatment and its clinical outcomes of cervical spinal cord injury without fracture and dislocation. Methods Twentysix cervical spinal cord injury patients without fracture and dislocation were performed posterior unilateral opendoor laminoplasty or anterior spinal decompression and reconstruction individually . The selection of the surgical procedure was based on the appearance of radiography. Neurological function (Frankel grade and JOA scoring system) were evaluated before and after operation. Results No severe vascuneurological complication occurred. The Frankel grade was improved significantly after operation compared with that of before operation. The preopevative and postoperative JOA score were 5.3?.5 and 12.2?.7 respectively. The improvement rate was 59 %. Conclusion Cervical spinal stenosis and cervical vertebra degenerative are the main pathological basis to cervical spinal cord injury without fracture and dislocation. Surgical treatment could achive an efficient outcome as long as the surgical procedure is selected correctly. ??? 【Key words】? cervical vertebra;? no fracture dislocation;? spinal cord injury;? operation ??? 随着人口老龄化的到来及交通事故等意外伤害的增加，无骨折脱位颈脊髓损伤在临床并不少见。随着对该类损伤研究的深入，大多数作者主张手术治疗。2001年7月～2008年4月我院共收治无骨折脱位型颈脊髓损患者 26 例，根据受伤机制及影像学表现的不同，分别选用了后路单开门椎管扩大成形术或前路减压植骨融合内固定术，效果满意，现总结如下。 ??? 1? 临床资料 ??? 1.1? 一般资料 ??? 本组男性19例，女性7例，年龄38～72岁，平均 57.5岁，年龄小于50岁者2例，其余均在50岁以上。致伤原因：走路跌伤9例，骑自行车摔伤3例，车祸伤7例，坠落伤5例，重物砸伤1例，前额碰壁致伤1例。按受伤机制划分：颈部过伸性伤19例，屈曲性伤5例，受伤机制不明确2例。术前予以颈部制动、激素、脱水等治疗，手术时间在伤后3～37 d，平均7.5 d. ??? 本组患者中11例(42.3 %)伤前有轻微的颈肩痛或四肢麻木等不适，伤后均有不同程度的脊髓损伤，表现为四肢