无骨折脱位型颈脊髓损伤的局部麻醉手术策略

目的探讨局部麻醉下治疗无骨折脱位型颈脊髓损伤的手术策略及治疗效果。方法回顾分析2004年3月~2009年2月间采用局麻方式治疗的无骨折脱位型颈脊髓损伤病例62例,根据损伤机制及影像学资料将无骨折脱位型颈脊髓损伤形成因素分为3类,其中Ⅰ类11例,Ⅱ类34例,Ⅲ类17例。Ⅰ类采用前路减压融合术,Ⅱ类采用后路椎管扩大减压术,Ⅲ类采用后路椎管减压融合术（或前后路联合减压融合术）。根据JOA评分观察手术前后及随访时的神经功能变化并进行对比分析。结果经3个月,6个月,1年及终末随访,其中终末随访JOA评分均较术前明显改善（P〈0.05）,优良率达88.7%。术后出现颈后路表浅感染2例,C5神经根症状5例。未发生医源性神经损伤加重、内固定失败、后路单开门术后再关门等并发症。结论在局麻方式下采用颈前路、后路或前后路联合入路减压（和/或融合）治疗无骨折脱位型颈脊髓损伤均取得良好疗效,根据影像学表现结合致伤因素在局麻方式下合理选择手术入路是手术成功的关键。

Surgical treatment of cervical spinal cord injury without fracture and dislocation under local anesthesia

Objective To discuss the surgical treatment and its clinical outcomes of adults cervical spinal cord injury without fracture and dislocation under local anesthesia.Methods Three surgical protocols were performed on 62 cases of cervical spinal cord injury without fracture and dislocation under local anesthesia since March 2004 to February 2009.The selection of the surgical procedures was based on these patient＇s trauma mechanism and image characters.There were 11 cases of anterior spinal reconstruction and decompression,34 cases of posterior spinal cord decompression,and 17 cases of posterior spinal cord decompression plus spinal reconstruction.The JOA score in each patient before and after operation was reviewed to assess the neurological status due to 3 different surgical protocols.Results At 3rd month,6th month,1st year after operation and the final follow-up,JOA score was improved significantly compared with preoperation（P0.05） with excellent rate being 88.7%.Postoperative posterior superficial infection occurred in 2 cases,and C5 nerve root pain in 5 cases.There were no aggravated iatrogenic nerve injury,fixation failure,posterior single door closure and other complications after surgery.Conclusion Surgical treatment of cervical spinal cord injury without fracture and dislocation under local anesthesia can achieve an efficient and safe clinical outcome,while reliable selection of surgical procedure is based on carefully considering the patient＇s status before operation.