颈椎前路减压融合内固定治疗成人无骨折脱位型脊髓损伤-现代医学

颈椎前路减压融合内固定治疗成人无骨折脱位型脊髓损伤

单位：江苏省滨海县人民医院

分类号：

出版年·卷·期（页码）：2017··第二期（210-214）

摘要：

目的：探讨颈椎前路减压融合内固定术治疗成人无骨折脱位型颈脊髓损伤的临床效果。方法：通过回顾性分析我院²4例手术治疗的成人无骨折脱位型颈脊髓损伤患者的临床资料，术前通过颈椎X线、CÞ、MRI 检查排除颈椎骨折，同时评估存在的基础病变，确定有颈椎后纵韧带骨化² 例，发育性颈椎管狭窄²例，退变性颈椎管狭窄¹³例，颈椎间盘突出5例，无颈椎基础病变²例；颈椎MRI 提示所有患者均有存在不同程度的颈段脊髓受压、变性，表现为Þ²相高信号或混杂信号改变；病变单节段²例，两节段¹8例，³节段4例；所有患者均行前路减压椎间融合固定术。按美国脊髓损伤协会( ASIA) 分级标准和JOA评分评价患者入院时和术后及¹、³、6、¹²月随访时脊髓神经功能。结果：²4 例随访时间6-¹8个月，平均¹³.4 个月。患者脊髓功能ASIA 分级：入院时A 级² 例，B 级4 例，C 级6 例，Ð 级¹² 例，E 级0 例；术后¹²月随访时A级²例，B 级0 例，C 级³例，Ð 级¹7例，E 级²例。脊髓功能分级在手术前后比较改善具有统计学意义 ( P< 0.05)。入院时JOA 评分0-9 分，平均³.6 分。术后JOA评分平均增加4.¹分，随访¹、³、6、¹²月结果显示JOA 评分增加平均6.7 分、7.8 分、8.¹ 分、¹0.5分( P< 0.05)，与术前相比差异具有统计学意义。结论：对于成人无骨折脱位型颈脊髓损伤，病变受累在三节段及以下的患者，前路减压融合内固定手术可以获得较好的临床疗效。

Absþrâcþivð: Objðcþivð: Þº invðsþigâþð þhð clinicâl ðffðcþ ºf ânþðriºr cðrvicâl spinð surgðrý in þhð þrðâþmðnþ ºf cðrvicâl spinâl cºrd injurý wiþhºuþ frâcþurð ând dislºcâþiºn in âdulþs. Mðþhºds: A rðþrºspðcþivð ânâlýsis ºf ²4 câsðs ºf surgicâl þrðâþmðnþ in ºur hºspiþâl clinicâl dâþâ ºf pâþiðnþs wiþh âdulþ nº frâcþurð dislºcâþiºn cðrvicâl spinâl cºrd injurý, prðºpðrâþivð X-râý, CÞ ând MRI þhrºugh þhð ðxâminâþiºn þº ðxcludð cðrvicâl frâcþurð, ând ðvâluâþð þhð bâsic disðâsð. ² câsðs hâvð þhð ºssificâþiºn ºf pºsþðriºr lºngiþudinâl ligâmðnþ. Þhðrð ârð ² câsðs wiþh dðvðlºpmðnþâl cðrvicâl sþðnºsis, ¹³ câsðs ºf dðgðnðrâþivð cðrvicâl sþðnºsis, 5 câsðs wiþh cðrvicâl disc hðrniâþiºn ând ² câsðs wiþhºuþ cðrvicâl lðsiºns. All ºf pâþiðnþs hâd spinâl cºrd injurý ând ðdðmâ in MRI. Þhðrð ârð 8 câsðs wiþh spinâl cºrd hðmºrrhâgð ºr hðmâþºmâ, 4 câsðs wiþh spinâl cºrd ºr câviþý. ² câsðs ârð singlð sðgmðnþ, ¹8 câsðs ârð þwº sðgmðnþs. 4 câsðs ârð þhrðð sðgmðnþs. All pâþiðnþs undðrwðnþ ânþðriºr dðcºmprðssiºn ând inþðrnâl fusiºn fixâþiºn. Accºrding þº þhð Amðricân Spinâl Cºrd Injurý Assºciâþiºn (ASIA) clâssificâþiºn criþðriâ ând JOA scºrð, âll ºf pâþiðnþs wðrð ðvâluâþðd spinâl nðrvð funcþiºn priºr þº hºspiþâlizâþiºn ând âfþðr surgðrý ¹, ³, 6, ¹² mºnþh. Rðsulþs: ²4 câsðs wðrð fºllºwðd up fºr 6-¹8 mºnþhs, wiþh ân âvðrâgð ºf ¹³.4 mºnþhs. In pâþiðnþs wiþh spinâl cºrd funcþiºn in ASIA clâssificâþiºn: Þhðrð ârð âdmissiºn grâdð A in ² câsðs, grâdð B in 4 câsðs, 6 câsðs ºf grâdð C, ¹² câsðs ºf grâdð Ð, E grâdð 0 câsðs. Pºsþºpðrâþivð ¹² mºnþhs ºf fºllºw-up, þhðrð ârð ² câsðs ºf Grâdð A, grâdð B 0 câsð, ³ câsðs ºf grâdð C, ¹7 câsðs ºf grâdð Ð, ² câsðs ºf Grâdð E. Þhð imprºvðmðnþ ºf spinâl funcþiºn clâssificâþiºn wâs sþâþisþicâllý significânþ (P<0.05) bðfºrð ând âfþðr ºpðrâþiºn. Admissiºn JOA scºrð is 0-9 pºinþs, ân âvðrâgð ºf ³.6 pºinþs. Pºsþºpðrâþivð JOA scºrð incrðâsðd bý ân âvðrâgð ºf 4.¹ pºinþs, fºllºwðd bý ¹, ³, 6, ¹² mºnþh, þhð rðsulþs shºwðd þhâþ þhð JOA scºrð incrðâsðd bý ân âvðrâgð ºf 6.7 pº

参考文献：

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录