无骨折脱位型颈脊髓损伤外科治疗随诊观察

目的 :探讨脊髓损伤程度、治疗方法及手术时机对无骨折脱位型颈脊髓损伤疗效的影响。方法 :对 118例手术治疗的无骨折脱位型颈脊髓损伤患者平均随访 30 3个月 (1～ 16 3个月 ) ,74例随访 1年以上 (平均 4 6 3个月 )。观察 :(1)伤后 3种不同脊髓功能状况的治疗效果 (A组 :受伤时呈完全性瘫痪 ,70例 ;B组 :不完全性瘫痪 ,4 2例 ;C组 :上肢部分瘫痪、下肢完全性瘫痪 ,6例 )。 (2 )保守治疗与手术治疗的效果。 (3)手术时机 (伤后 <12个月、>12个月 )对疗效的影响。并做统计学分析。结果 :(1) 3组之间在保守治疗效果、术后近期效果和后期随访结果上无显著性差异。 (2 ) 3组均经保守治疗 ,平均为 2 1 3个月。保守治疗的效果与术后近期、尤其与后期随访结果相比 ,JOA评分较低 ,存在统计学上的差异。 (3)伤后 <12个月和 >12个月手术的患者后期随访结果具有统计学上的差异。前者术后近期和后期脊髓功能恢复都较满意 ;后者术后近期恢复较明显 ,但后期脊髓功能却出现倒退现象。结论 :无骨折脱位型脊髓损伤患者不同的脊髓功能状况对脊髓功能恢复程度无影响 ;手术治疗效果明显优于保守治疗 ;手术时机对后期脊髓功能恢复有重要影响。最迟不应超过伤后 12个月

The follow-up of surgical treatment of cervical spinal cord injury without fracture and dislocation

Objective:To reveal the influence of timing of surgery on the outcome of cervical spinal cord injury without fracture and dislocation.Method:118 cases were treated surgically and obtained follow up with average 30 3 months and 74 cases had follow up over one year,46 3 months on an average.Result:(1)There were 70 patients who appeared complete qudriplasia when they were injured.42 cases only experienced numbness and weakness on extremities when they had accident.The rest of 6 patients felt numb and weak on upper limbs and had paraplagia on lower limbs.There was no difference statistically on conservative,short and long term operative outcome among three groups.(2)All patients had some very limited and uncertain recovery after an average 21 3 months of conservative treatment.There was a significant difference on outcome between conservative and surgical treatment.(3)The long term outcome between patients who had operation within 12 months after the injury and who had operation beyond 12 months was statistically different.The long term outcome of patients having surgery within 12 months was much better than those beyond 12 months.Conclusion:For the cervical spinal cord injury without fracture and dislocation:(1)The condition of spinal cord function has no influence on the long term recovery of spinal cord.(2)The effect of operative treatment is significantly superior to the conservative.(3)The timing of surgery has important effect on the late recovery of spinal cord.The best timing of surgery should be within 2 months after the injury.For the latest timing should not be beyond 12 months otherwise the long term outcome of spinal cord function will be spoiled.