高位颈髓压迫症的治疗策略

目的：探讨高位颈髓压迫症的外科治疗。方法：商位颈髓压迫症228例，其中齿突骨折58例（新鲜骨折38例，陈旧性骨折20例），Hangman骨折45例（其中新鲜骨折28例，陈旧性骨折17例），寰椎横韧带断裂24例，寰椎单侧后弓骨折19例，类风湿性天节炎17例，一侧关节突骨折9例，Jefferson骨折并慢性不稳3例，先天畸形48例，肿瘤4例。根据复位情况及脊髓受乐部何选择不同的术式，重建其稳定性。结果：平均随访4年11个月。JOA评分术前平均7．5分，随访时评分14．9分，改善率79．9％。结论：充分减压是最大限度恢复神经功能的有效方法，稳定性的重建非常必要。

Surgical Management for High Spinal Cord Compression

Objective： To discuss surgical management for high spinal cord compression. Methods： 228 patients with high spinal cord compression were included in this study. Among them, there are 58 eases of odontoid fracture （including 38 cases of fresh fractures and 20 cases of timeworn fractures）, 45 cases of Hangman fracture（including 28 cases of fresh fractures and 17 cases of timeworn fractures）, 24 cases of torn transverse ligament of atlas, 19 cases of unilateral fracture of posterior vertebral arch of atlas, 17 cases of rheumatoid arthritis, 9 cases of unilateral fracture of articular process, 3 cases of Jefferson fracture with chronic instability, 48 c, ases of congenital deformity and 4 cases of spinal tumor. Different operation methods were choosed according as diaplasis and orientation of spinal cord oppression, and reconstruction of spinal stability was carried out. Results： With an average follow-up period of 4 years and 11 months, average JOA grade was 7.5 preoperatively and was 14.9 at follow-up duration, the rate of improvement was 79.9%. Conclusion： Thoroughly decompression is the main method for maximum improvement of the nerve function and spinal stability reconstruction.