陈旧性颈髓损伤的外科治疗

目的：观察颈椎减压融合手术对陈旧性颈椎骨折脱位引起的颈脊髓或神经根损伤的治疗效果。方法：1999年1月～2003年12月手术治疗因颈椎骨折脱位合并不同程度颈脊髓损伤后1个月以上的患者58例，总结临床资料，比较手术前后感觉运动功能的改善程度。结果：平均随访27个月。术前ASIA分级A级的7例患者术后上肢有1～2个神经根功能改善者3例，下肢出现肌肉活动功能改善者2例：术前B级的11例患者术后8例上肢活动有改善，6例出现下肢功能改善；术前C级6例患者术后达D级3例，E级3例：术前D级34例患者术后达到E级24例，10例仍为D级。所有患者术后ASIA的感觉及运动评分较术前明显提高（P〈0．05）。结论：减压融合手术对陈旧性颈椎骨折脱位引起的颈脊髓损伤或神经根损伤仍是有效的治疗方法，脊髓功能的恢复与脊髓损伤程度有关。

Surgical treatment of old cervical spinal cord injury

Objective:To observe the effect of delayed decompression and fusion on the treatment of spinal cord injury caused by old fracture and dislocation of cervical spine.Method:The clinical data of 58 patients who had spinal cord injury secondary to a fracture or dislocation of the cervical spine were analyzed,operations performed for decompression and fusion of cervical spine were delayed for more than 1 month,the average interval from the injury to the decompression was 5 months,the mobility and sensation of extremities and strength of muscles were recorded before and post operation,the neurological and functional level were classified according to ASIA grade system,and recorded from the beginning of hospital admission to the most recent follow-up.Result:The average time of follow-up was 27 months.3 cases got 1~2 new motor-root functional improvement in upper extremity and 2 cases got functional improvement in lower extremity among 7 grade A cases.8 cases showed motor-root functional improvement in upper extremity,6 showed functional improvement in lower extremity in 11 grade B cases.Among 6 grade C cases,3 cases reached to grade D and 3 to grade E.34 grade D cases all had improvement of muscle strength and sensation,24 cases reached to grade E.All cases showed significant increase in ASIA score of motor and pin prick in most recent follow-up compared with that before operation(P<0.05).Conclusion:Decompression and arthrodesis are still effective on the neurological improvement in some patients who had spinal cord or nerve root injury secondary to old fracture or dislocation of cervical spine.