跳水致颈髓损伤早期综合治疗的疗效评价

目的]探讨跳水致颈髓损伤早期综合治疗的临床效果。方法]2001～2005年27例跳水致颈脊髓损伤患者，其中脊髓完全性损伤15例，脊髓不完全性损伤12例。早期综合治疗方案包括：（1）全身治疗：维持呼吸道通畅和有效循环血容量，保证收缩压在90mmHg以上；血氧饱和度在90％以上；（2）早期应用大剂量甲基强的松龙或地塞米松等药物治疗；（3）颅骨牵引制动或颈椎复位；（4）早期进行手术减压植骨融合内固定术；（5）术后早期行高压氧治疗。术后定期复查x线片观察损伤节段的稳定性和植骨融合率以及有无内固定并发症。以ASIA分级标准和感觉、运动评分判定脊髓神经功能恢复情况。结果]27例患者随访6～36个月，平均28个月；本组病例无术中、术后并发症，切口愈合良好；术后3个月复查x线片，损伤节段稳定，植骨融合良好，无钢板断裂、螺钉松动脱落等现象。13例患者神经功能获得改善，总有效率为48．1％，其中完全性损伤组有效率为20％，不完全性损伤组有效率为83．3％。完全性损伤患者ASIA分级变化不明显，但其评分较入院时可有相应的增加，不完全性损伤患者ASIA分级和感觉运动评分均有明显的提高。结论]颈髓损伤后早期综合治疗可以促进脊髓神经功能恢复。

Evaluation of early composite treatment for cervical spinal cord injury caused by diving injury

Objective] To evaluate the therapeutic effect of early composite treatment in patients with cervical spinal cord injury(SCI) caused by diving injury.Method]27 patients of SCI caused by diving injury,including complete SCI in 15 patients and incomplete SCI in 12 patients,were analyzed.Early composite treatment scheme were as follows:(1) systemic treatment: respiratory support and effective circulation volume for maintenance of systolic pressure more than 90mmHg and oxygen saturation more than 90%.(2) Early pharmacological treatment such as methylprednisolone and dexamethasone.(3) Immobilization and reduction of the injured cervical spine by skull traction.(4) Early cervical decompression,reduction,graft and internal fixation.(5) Early hyperbaric oxygen therapy after operation.The stability and fusion of the injured segments and the complications of the hardware were observed on the X-ray film postoperatively.The spinal cord function was evaluated with ASIA grades and sensorymotor scores.Result]All 27 patients were followed up for 12 to 36 months,with an average of 28 months.No intra-operative and post-operative complications,the incision healed well.The injured segments were stable and all bone grafts acquired fusion in 3 months,no plates or screws broken or loosen.The neurological recovery were detected in 13 patients.The neurological recovery rate was 20% in complete SCI,83.3% in incomplete SCI,48.1% in the total.The ASIA grades of the sensory and motor scores could hardly be improved postoperatively in complete spinal cord injury while in incomplete spinal cord injury the ASIA grades and sensorymotor scores increased significantly.Conclusion]Early composite treatment of cervical spinal cord injury caused by diving injury can significantly improve neurological function of the cervical spinalcord injury patients.