无骨折脱位型颈脊髓损伤手术治疗临床研究-第三军医大学学报.DOCVIP

无骨折脱位型颈脊髓损伤手术治疗临床研究 邵高海 王群波 李波 钟斌 余雨 杜维 重庆市第二人民医院骨科（402160） 摘要 目的 探讨无骨折脱位型颈脊髓损伤手术治疗的临床效果。方法 通过回顾分析我院自2002年10月到2008年3月手术治疗无骨折脱位型颈脊髓损伤39例患者，按日本颈脊髓损害评定标准JOA 17分评分法，术前评分平均5.15分 ，手术均经前路进入，8例采用了椎间隙减压植骨融合术，31例采用了椎体次全切除减压植骨融合术，其中5例保留椎体后壁的椎体次全切除，11例切除钙化的后纵韧带。结果 所有患者获得随访，随访时间8-72月，平均随访时间32月。有9例患者恢复较好，生活能自理，22例患者有不同程度恢复，生活需要照顾，8例患者无效。按JOA 17分法评分，术后2周JOA评分平均7.15分，术后6周JOA评分平均达9.89分，术后3月JOA评分平均10.2分，术后 6月JOA评分平均11.41分。远期随访JOA平分平均达到12.09分。结论 无骨折脱位型颈脊髓损伤要严格手术指征，对椎管严重狭窄，以颈椎间盘突出为主要病理改变，MRI示水肿性脊髓损伤或脊髓血肿或挫伤高信号长度≦5mm等应尽早手术减压。 关键词 无骨折脱位 颈脊髓 减压 Analysis of operative treatment for cervical spinal injury without fracture and dislocation Shao gao hai Wang qun bo Li bo Zhong bin Yu yu Du wei。 Department of orthopaedic surgery，The second people′s hospital of chong qing 【Abstract】Objective　To study the clinical effects of cervical spinal injury without fracture and dislocation with operative treatment. Methods　From Octorber 2002 to Match 2008, 39 cases with cervical spinal injury without fracture and dislocation, which received surgical treatments, were reviewed and analyzed. The average preoperative score were 5.15 points in terms of the JOA criteria. They all underwent anterior cervical operation, 8 cases with the degenerative discs removed and bone graft fusion, 31 cases with single or multiple vertebral resection and bone graft fusion, in which 5 case preserved vertebral posterior wall and 11 cases eliminated calcifying posterior longitudinal ligament. Results All cases were followed up.The duration of follow up averaged 32 months(ranged 8～72 months). 9 cases showed better neurological recovery, 22 cases had partial improvement and 9 cases had no change. In terms of the JOA criteria, the average score were 7.15 points in 2 weeks preoperativly , 9.89 points in 6 weeks, 10.2 points in 3 months , 11.41 points in 3 months and 12.09 points in longer follow up. Conclusion　The patients with cervical spinal injury without fracture and dislocation should be operated