外科针对性减压治疗无骨折脱位颈脊髓损伤

目的总结外科针对性减压治疗无骨折脱位的颈脊髓损伤的临床疗效和手术方式选择。方法 2007年1至2011年3月,共收无骨折脱位的颈脊髓损伤31例,男23例,女8例;年龄17～71岁,平均年龄41.5岁;病理基础:先天性颈椎管狭窄3例,退变性颈椎管狭窄11例,急性颈椎间盘突出5例,后纵韧带骨化3例,颈椎不稳3例,黄韧带骨化1例,椎间盘突出合并椎管狭窄2例,颈椎不稳合并椎管狭窄3例;JOA脊髓功能评分为0-8分,平均4.5分。在有效维持患者生命体征的前提下,针对不同病理基础分别采用前路减压融合、后路椎板开门椎管扩大成形、后路椎板开门椎管扩大成形结合前路减压融合、后路椎板开门椎管扩大成形结合侧块螺钉固定等手术方式进行减压治疗,观察神经功能改善情况。结果所有患者平安度过围手术期并获得8～55个月随访,平均38.6个月,JOA脊髓功能评分为9～17分,平均13.2分。改善率为64.4%;优良率为79.8%。结论针对不同病理基础所致的无骨折脱位的颈脊髓损伤进行有针对性减压治疗,可取得较好的神经功能改善。

Surgical direct decompression treatment for cervical spinal cord injury without fracture or dislocation

Objective To summarize the therapeutic effect of surgical direct decompression treatment for cervical spinal cord injury without fracture or dislocation and the choice of operative modus. Methods Thir- ty-one patients with cervical spinal cord injury without fracture or dislocation were treated by surgical direct de- compression,23 males and 8 females, aged from 18 to 71 years old averaged 56. 5 years old;pathology funda- ment：3 with inborn cervical spinal stenosis, 11 with degenerative cervical spinal stenosis,5 with acute cervical intervertebral disk hernia, 3 with ossification of posterior longitudinal ligament, 3 with cervical instability, 1 with ossification of the yellow ligament,2 with acute cervical intervertebral disk hernia and spinal stenosis, 3 with cer- vical instability and spinal stenosis. According to spinal cord fuction scoring system of Japanese Orthopaedics As- sociation, the score was from 0 to 8, the average score was 4.5. Under the premise of effective vital sign, accord- ing to different pathology fundament. Patients were treated by anterior decompression fusion, posterior lamin- oplasty, posterior laminoplasty and anterior decompression fusion, posterior laminoplasty and lateral mass screw fixation, the improvement of nerve fuction was observed. Results All patients pulled through the period time of operation securely and were followed up from 8 months to 55 months, average 38. 6 months. At the latest fol- lowed-up time,the score of JOA was from 9 to 17, the average score was 13.2 nerve improvement rate was 64. 4%, fineness rate was 79. 8%. Conclusion Direct decompression treatment for cervical spinal cord injury without fracture or dislocation was undertaken according to diffent pathology fundament, which could gain good nerve function improvement