无骨折脱位型颈脊髓损伤再手术原因分析

目的:探讨无骨折脱位型颈脊髓损伤患者再次手术治疗的原因,总结经验教训。方法:对1993年1月～2003年2月间13例经再次手术治疗的无骨折脱位型颈脊髓损伤患者的临床资料进行回顾性分析,根据其影像学表现,分析致伤的病理基础与形成因素的特点。结果:患者再手术的原因主要有:(1)前次手术入路选择不当(8例);(2)前次手术中脊髓减压不彻底(5例)。再手术后均获随访(平均43个月),神经功能得到了一定的改善(JOA评分改善率平均为40.6%)。结论:手术入路选择不当和减压不彻底是无骨折脱位型颈脊髓损伤再手术的主要原因,再次手术治疗应针对此类损伤致伤特点,选择合理的手术入路,并矫正前次手术不当之处,可获得一定的疗效。

The analysis to the causes of reoperation in cervical spinal cord injury without fracture and dislocation

Objective:To evaluate and analyze the different causes and experiences of operation in patients of cervical spinal cord injury without fracture and dislocation undergone previous surgery.Method:13cases of such injury undergone secondary surgical treatment during the period of January1993to February2003were analyzed retrospectively.According to their imaging appearance,pathological elements and the character of occurring factors of the injury were analyzed.Result:The main causes of reoperations in this group of patients included:(1)Choice of approaches of previous operations was not suitable(8cases).(2)In the previous operations,decompressions of spinal cord were not sufficient(5cases).The follow-up study was carried out(a mean period of43months)in all these patients undergone reoperations.As a result,the spinal cord functions of the patients have been improved in a certain extent(the recovery rate of JOA score was40.6%).Conclusion:Unsuitable choice of approach and insufficient decompression of spinal cord in previous operation were main causes led to another operation in patients of cervical spinal cord injury without fracture and dislocation.Therefore,the reoperation should aim at the character of occurring factors of the injury,select correct surgical approaches,and rectify unsuitable aspects in previous surgery etc.And the further revision surgery can indeed provide improvement in a certain extent.