中央型脊髓损伤患者术后脊髓功能恢复特征:11例分析

背景颈段脊髓损伤的治疗有多种方式,但效果均不十分理想.目的探讨手术等综合治疗对颈椎中央型脊髓损伤患者术后功能恢复的影响.设计前后对照设计.单位一所大学医院的骨科病房.对象1999-01/2003-01江苏省人民医院骨科共收治中央型脊髓损伤患者11例,均为男性,年龄36～65岁,交通事故9例,跌伤1例,头部砸伤1例,病程2 h～14 d,伴颈椎间盘突出9例,颈椎管狭窄1例,C6椎体骨折1例.MRI片单处损伤9例,两处损伤2例.方法伤后4～20 d手术治疗,9例行前路颈椎间盘摘除植骨加钢板内固定,2例行颈椎后路减压植骨加侧块钢板内固定.主要观察指标①患者手术前后Frankel分级.②手术后脊髓功能恢复结果.结果11例患者术前Frankel分级为0级3例、Ⅰ级3例、Ⅱ级5例.术后为0级1例、Ⅲ级4例、Ⅳ级6例.平均肌力恢复2～5级,复查内固定牢靠、在位,植骨愈合良好.结论颈椎中央型脊髓损伤一旦确诊提倡以手术为主的综合性治疗措施,手术尽可能去除致病因素,其他辅助措施则以促进脊髓功能恢复为目的.

Characteristics of functional recovery of spinal cord after operation for central spinal cord injury: 11 cases analysis

BACKGROUND: There are many treatment approaches of the cervical spinal cord injury but the results were all unpleased.OBJECTIVE: To discuss the effect of the operation and other colligate treatments on the functional recovery of the patients who suffered from the cervical central spinal cord injury.DESIGN: A preoperative and postoperative control study.SETTING: Orthopaedic department in an affiliated hospital of a university.PARTICIPANTS: Eleven male patients of the central spinal cord injury,whose ages ranged from 36 to 65, were chosen from the Orthopedic Department of People' s Hospital of Jiangsu Province from January 1999 to January 2003. Nine cases suffered from traffic accidents. One case suffered from falling injury. One case suffered from head smash injury. The courses of diseases were from 2 hours to 14 days. Nine cases were accompanied with the cervical intervertebral disc herniation. One case was accompanied with the cervical vertebral canal stenosis. One case was accompanied with the fracture of the C6 vertebral body. Nine cases showed single segment injury and 2 cases showed two segment injuries in the MRI plate.METHODS: The operation was done 4 to 20 days after the injury. Anterior cervical intervertebral disc removal, bone implantation and the internal fixation of the armor plate were done in 9 cases. Posterior route cervical vertebral depression, bone implantation and internal fixation of the lateral armor plate were done in 2 cases.tion.RESULTS: Before the operation 11 cases were classified according to the Frankel Grade: 3 cases of 0 grade, 3 cases of Ⅰ grade and 5 cases of Ⅱ grade. After the operation 1 case of 0 grade, 4 cases of Ⅲ grade, and 6 cases of Ⅳ grade. The mean muscular power recovered 2 to 5 grades. The re-examination of the internal fixation was firm and right-located. The implanted bone healed well.CONCLUSION: After the diagnosis of the cervical central spinal cord injury, the colligate treatment is suggested. The operation removes the pathogenic factors as soon as possible, and other assistant treatments promote the functional recovery of the spinal cord.