脊髓型颈椎病自然史规律研究

目的了解脊髓型颈椎病的发病规律,评价自然史在早期诊断和治疗中的意义.方法综合分析1 263例脊髓型颈椎病(CSM)患者的自然史,将其演变方式归纳为5型,Ⅰ～Ⅳ型为起病轻者,其中Ⅱ～Ⅳ型无论是否经过稳定期,最后均出现恶化,Ⅰ型长期保持稳定,随访期内无恶化倾向或结果,Ⅴ型为突然严重起病,无法缓解者.结果Ⅰ型137例(10.88%),Ⅱ型534例(42.31%),Ⅲ型96例(7.57%),Ⅳ型407例(32.24%),Ⅴ型89例(7.05%).结论脊髓型颈椎病仅少数长期处于良性稳定状态,该病多数呈相对恶性的发展趋势,其发展结果将造成更加严重的脊髓损害.下肢麻木、行走缓慢、步态异常、手臂麻木、精细动作障碍等可作为早期诊断的参考要点.

Cervical Spondylotic Myelopathy:Regularity of Nature History

Objective:To understand the regularity of nature history of cervical spondylotic myelopathy (CSM) and evaluate its importance on early diagnosis and treatment.Methods:Analyze the nature history of 1263 cases of CSM.The course of these cases prior to surgery are classified into five patte ns.The initial symptoms in pattern 1-4 are slight.Cases in pattern 2-4 showed deterioration in the end with or without going through a static period.Cases in pattern 1 keep a static condition for a long time and did not show deterioration in the follow-up periods.Cases in pattern 5 had an abruptly onset with serious symptoms,and without regression in the following time.The onset condition and i nitial characteristics are analyzed.Results:Pattern 1,137 cases (10.88%).Pattern 2,534 cases(42.31%).Pattern 3,96 cases (7.57%).Pattern 4,407 cases(32.24%).Patt ern 5,89 cases (7.05%).Conclusions:Few of the CSM patients keep in long-term as benign condition.The developing trend of most patients are relatively malignant .The final results reveal more serious spinal cord injury.Numbness of the lower extr emities,slow walking,abnormality of gait,numbness of the hands and disturbance o f fine motion are suggested as the reference point of the CSM early diagnosis.