无骨折脱位型颈脊髓损伤治疗方法的选择

目的　比较手术和非手术治疗无骨折脱位型颈脊髓损伤后脊髓功能恢复程度的差异。方法　回顾性分析28例无骨折脱位型颈脊髓损伤患者,其中13例行非手术治疗, 15例行手术治疗,根据损伤时日本骨科学会(JOA)评分标准,经随访比较治疗前后JOA评分的增加幅度。结果　治疗后3个月JOA评分的增加幅度:非手术组为1. 92±0. 58,手术组为4. 93±0. 91,治疗后6个月JOA评分的增加幅度:非手术组为2. 71±0. 64,手术组为6. 24±0. 93;治疗后12个月JOA评分的增加幅度:非手术组为4. 23±0. 75,手术组为7. 80±0. 98。经t检验,两组差异均有非常显著性意义(P<0. 01)。结论　手术治疗效果明显优于非手术治疗,无骨折脱位型颈脊髓损伤一旦确诊,应积极争取早期手术。

The treatment choices for cervical spinal cord injury without fracture and dislocation

Objective To compare the difference of functional recovery level of spinal cord after surgical treatment or conservative treatment of cervical spinal cord injury without fracture and dislocation. Methods Twenty-eight cases of cervical spinal cord injury without fracture and dislocation were retrospectively analyzed and divided into surgical group(n=15) and conservative group (n=13). Japanese Orthopaedic Association (JOA) scores at injury and during follow-up were recorded to make a comparison of the increase amplitudes between the two groups before and after treatment. Results The increase amplitudes of JOA scores were 1.92±0.58 in the conservative group and 4.93±0.91 in the surgical group 3 months after treatment, 2.71±0.64 and 6.24±0.93 respectively 6 months after treatment, and 4.23±0.75 and 7.80±0.98 respectively 12 months after treatment. There was a significant difference statistically both in the two groups by t test (P<0.01). Conclusion Surgical treatment is superior to conservative treatment. Once the final diagnosis of cervical spinal cord injury without fracture and dislocation is verified, the surgical treatment should be carried out as early as possible.