Ⅰ型无骨折脱位型颈髓损伤经颈前路手术与非手术治疗效果比较Comparison of Clinical Effect of Anterior Cervical Surgery and Non-Surgical Treatment in Patients with Type Ⅰ SCIWORA
杨磊落;李青;彭吾训;王春庆;潘廷;肖正亮;安平江;
YANG Leiluo;LI Qing;PENG Wuxun;WANG Chunqing;PAN Ting;XIAO Zhengliang;AN Pingjiang;Department of Orthopedics,the Affiliated Hospital of Guizhou Medical University;
摘要(Abstract):
目的:比较Ⅰ型无骨折脱位型颈髓损伤(SCIWORA)行颈前路手术与非手术治疗的疗效。方法:86例Ⅰ型SCIWORA患者分成手术组(62例)和非手术组(24例),手术组患者根据受损椎间盘节段数量,43例行经颈前路单节段椎间盘摘除及椎间植骨融合内固定术;19例行经颈前路椎体次全切除、双节段病变间盘摘除及椎间植骨融合内固定术,非手术组常规给予甘露醇、激素、营养神经等对症治疗,分别在治疗后2周、4周、3个月、6个月、1年采用JOA评分比较两组患者脊髓功能改善情况,治疗后1年,采用ASIA评分比较两组患者神经功能改善情况。结果:治疗后4周、3个月、6个月、1年两组患者JOA评分差异均有统计学意义(P<0.05),手术组脊髓功能改善率优于非手术组;治疗后1年,两组患者ASIA评分差异有统计学意义(P<0.05),手术组神经功能改善率优于非手术组。结论:Ⅰ型SCIWORA经颈前路手术治疗后脊髓功能和神经功能恢复良好,疗效满意,值得进一步临床推广。
Objective: To compare clinical effect of anterior cervical surgery and non-surgical treatment in adult patients with type I SCIWORA. Methods: 86 cases of patients with SCIWORA were divided to two groups,of whom 62 cases went to surgery group and 24 cases went to non-surgical group.JOA score was adopted to evaluate recovery of spinal cord function 2 weeks,4 weeks,3 months,6months and 1 year after corresponding treatment in the two group. ASIA was adopted to evaluate recovery of neurological function in both groups after 1 year of treatment. Results: JOA score of two groups were significantly different 4 weeks,3 months,6 months and 1 year after treatment( P < 0. 05),and the recovery rates of spinal cord function in surgery group was better than those in non-surgical group.ASIA score of two groups was significantly different after 1 year of treatment( P < 0. 05),and the recovery rates of neurological function in surgery group were better than those in non-surgical group.Conclusion: The recovery in spinal cord function and neurological function is good after anterior cervical surgery in patients with type I SCIWORA. Anterior cervical surgery is worthy of further application in clinic.
关键词(KeyWords):
脊髓损伤;外科手术;随访;神经功能
spine cord injuries;surgical procedures,operative;follow up;nerve function
基金项目(Foundation): 贵州省科技合作计划项目[黔科合LH字(2014)7149]
作者(Author):
杨磊落;李青;彭吾训;王春庆;潘廷;肖正亮;安平江;
YANG Leiluo;LI Qing;PENG Wuxun;WANG Chunqing;PAN Ting;XIAO Zhengliang;AN Pingjiang;Department of Orthopedics,the Affiliated Hospital of Guizhou Medical University;
Email:
DOI: 10.19367/j.cnki.1000-2707.2016.07.021
参考文献(References):
- [1]藏磊,刘忠军,党耕町,等.无骨折脱位型颈脊髓损伤的类型与治疗研究[J].中国创伤骨科杂志,2004(7):781-784.
- [2]平林冽ほか.日本整形外科学会颈髓症治疗成绩判定基准[J].日整会志,1994(68):490.
- [3]Spinal cord injury facts and figures at a glance[J].J Spinal Cord Med,2011(6):620-621.
- [4]Yin B,Tang Y,Ye JC.Sensitivity and specificity of in vivo difusion-weighted MRI in acute spinal cord injury[J].J Clin Neurosci,2010(9):1173-1179.
- [5]Como JJ,Samia H,Nemunaitis GA,et al.The misapplication of the term spinal cord injury without radiographic abnormality(SCIWORA)in adults[J].J Trauma Acute Care Surg,2012(5):1261-1266.
- [6]陈学明,许崧杰,刘亚东,等.无骨折脱位型颈脊髓损伤治疗方法的探讨[J].中国矫形外科杂志,2011(19):634-636.
- [7]Wang B,Liu H,Wang H,et al.Segmental instability in cervical spondylotic myelopathy with severe disc degeneration[J].Spine,2006(12):1327-1331.
- [8]祁文,唐晓菊,刘汝专,等.手术治疗急性无骨折脱位型颈髓损伤的回顾性分析[J].中国矫形外科杂志,2011(9):1507-1509.
文章评论(Comment):
|
||||||||||||||||||
|
- 杨磊落
- 李青
- 彭吾训
- 王春庆
- 潘廷
- 肖正亮
- 安平江
YANG Leiluo- LI Qing
- PENG Wuxun
- WANG Chunqing
- PAN Ting
- XIAO Zhengliang
- AN Pingjiang
- Department of Orthopedics
- the Affiliated Hospital of Guizhou Medical University
- 杨磊落
- 李青
- 彭吾训
- 王春庆
- 潘廷
- 肖正亮
- 安平江
YANG Leiluo- LI Qing
- PENG Wuxun
- WANG Chunqing
- PAN Ting
- XIAO Zhengliang
- AN Pingjiang
- Department of Orthopedics
- the Affiliated Hospital of Guizhou Medical University