后路广泛减压侧块螺钉固定治疗无骨折脱位长节段颈髓损伤

【目的】探讨无骨折脱位型长节段颈髓损伤的损伤机制以及后路广泛减压侧块螺钉内固定手术的治疗效果。【方法】对31例无骨折脱位型长节段颈髓损伤的患者，其中先天性颈椎管狭窄和继发性颈椎管狭窄的颈脊髓损伤共25例（80．65％）；伴后纵韧带钙化3例（9．68％）；伴多节段颈椎间盘突出2例（6．45％），采用后路广泛减压侧块螺钉内固定手术治疗，观察脊髓功’能的变化及评价其临床疗效。【结果】31例术后随访3～17个月，平均9个月，术静ASIA评分平均为96．63±6．4分，术后3周ASIA评分平均为158．53±12．4分，术后3个月ASIA评分平均为18i．68±12．6分，术前和术后两者有统计学显著性差异（P〈0．05），术后两者无统计学显著性差异（P〉0．05）。除2例术后脊髓功能无改善外，其余患者均有不同程度恢复。【结论】颈椎椎管狭窄是无骨折脱位型颈髓损伤的重要原因；作用因素有惯性作用和直接外力；后路广泛减压侧块螺钉内固定手术能获得较理想的脊髓功能恢复效果。

Posterior Wide Decompression and Lateral Mass Screw Fixation in the Treatment of Long-segment Cervical Spinal Cord Injury Without Fracture or Dislocation

[Objective]To explore the pathology, the injury mechanism and operative result of long-segment cervical spinal cord injury without fracture or dislocation. [Methods] Thirty one cases of long-segment cervical spinal cord injury without fracture or dislocation included 25 cases（80.65%） with congenital and secondary cervical spinal stenosis, 3 cases（9.68%） complicated with posterior longitudinal＇ ligament calcification and 2 cases（6.45 %） complicated with multiple cervical disc protrusion. All patients were operated by posterior wide decompression and lateral mass screw fixation. The changes of spinal function after operation were observed and the efficacy was assessed. [Results]All patients were followed up for 3-17 months （average 9 months）. The average preoperative ASIA score was 96.63±6.4 points. After 3 weeks and 3 months, the average ASIA score was 158.53±12.4 points and 181.68±12.6 points, respectively. There were significant differences （ P〈0.05） in ASIA score between preoperation and after 3 weeks and 3 months. There was no significant difference （ P〉0.05） in ASIA score between after 3 weeks and 3 months. Except 2 cases without improvement, the others had different degrees of restoration. [Conclusion]Cervical canal stenosis is the main reason of the cervical spinal cord injury without fracture or dislocation. The acting factors are the inertia and the direct outside force. Operation with posterior wide decompression and lateral mass screw fixation can achieve good recovery of spinal cord function.