中央脊髓综合征的手术治疗

背景：中央脊髓综合征是常见的不完全性颈脊髓损伤,目前关于其手术与非手术处理的利与弊仍是脊柱外科争论的焦点。目的：探讨中央脊髓综合征的手术治疗效果及预后。方法：回顾性分析2009年1月至2012年6月采用手术治疗的34例中央脊髓综合征患者的临床资料,男24例,女10例;年龄39~76岁,平均53.6岁;前路手术26例,后路手术8例。采用日本骨科协会（JOA）评分标准对患者神经功能进行评定,记录所有患者术前、术后6个月及末次随访的JOA评分,评估手术疗效并分析其预后情况。结果：34例患者全部获得随访,随访时间为6~23个月,平均（14.5±3.8）个月。术前JOA评分平均为（8.8±1.8）分,术后6个月提高至（13.9±2.1）分,末次随访为（14.6±1.5）分。术后6个月及末次随访时的评分改善率分别为（66.1±21.6）%和（73.6±15.2）%。术后1例发生脑脊液漏,1例发生硬膜外血肿,无一例发生椎动脉损伤、切口感染、内固定物失败等并发症。结论：手术解除椎管内的压迫是治疗中央脊髓综合征的有效方法。对于诊断明确的中央脊髓综合征,在全身情况允许的条件下,宜早期根据椎管内脊髓损伤的节段、压迫来源及程度等选择相应的手术方案,以改善脊髓内血供,减少脊髓继发性损害,促进神经功能的改善和恢复。

Surgical treatment of traumatic central cord syndrome

Background： Traumatic central cord syndrome is a common type of incomplete spinal cord injury, the advantages and disad- vantages of its surgical and non-surgical treatments have always been the bone of contention in the spine surgery field. Objective： To evaluate the effect and prognosis of surgical treatment for the traumatic central cord syndrome. Methods： To retrospectively analyze the clinical data of 34 patients who received surgical treatment for traumatic central cord syndrome from January 2009 to June 2012. Aged from 39-76, these 24 males and 10 females had an average age of 53.6. Twenty-six of them received the surgery from anterior approach, and the rest of them received from the posterior ap- proach. The Japanese Orthopaedic Association （JOA） scoring standard was adopted in assessing the neurological function of the patients. JOA scores were collected before and 6 months after the surgery, and also at the last follow-up. The surgical effect and prognosis were evaluated and analyzed. Results： All the 34 patients were followed up for a period of 6-23 months, the mean follow-up period was 14.5±3.8 months. The mean JOA score rose from 8.8±1.8 before the surgery to 13.9±2.1 six months after the surgery, and was increased to 14.6±1.5 at the last follow-up. The recovery rates at 6 months after the surgery and at the last follow-up were （66.1±21.6）% and （73.6± 15.2）% respectively. One patient experienced eerebrospinal fluid leakage after the surgery, another patient experi- enced spinal epidural hematoma, but no serious complications like vertebral artery injury, wound infection, or internal fixa- tion failure happened. Conclusions： Relieving the compression in spinal canal with surgical treatment is an effective way in treating the traumatic cen- tral cord syndrome. For the clearly diagnosed traumatic central cord syndrome, it is recommended that a surgical plan be tailored according to the segment of the injured spinal cord in the spinal canal and the source and the degree of the compression as earlier as possible if the patient＇s physical condition is allowed. So that the blood supply in the spinal cord can be improved, the second- arc lesion of the spinal cord can be reduced, and the improvement and recovery of the neurological function can be promoted.