中老年人无骨折脱位型颈髓损伤的治疗策略与并发症处理

【目的】探讨中老年人无骨折脱位型颈髓损伤的治疗策略与并发症处理。【方法】回顾性分析2003年1月-2008年12月期间我科收治、随访6个月以上、年龄50岁以上的39例中老年人无骨折脱位型颈髓损伤临床资料，对其受伤机制、神经功能损伤程度、影像学表现、治疗方法、疗效进行分析。【结果】所有患者平均随访8．6个月（6。14个月）。按Frankel脊髓损伤分级：A级4例改善至B级，B级12例改善至C和D级，C级11例改善至D和E级，D级6例改善至E级；非手术治疗和手术治疗前后ASIA评分增加幅度之间差异有统计学意义（P〈0．05）；两种后路术式治疗前后ASIA评分增加幅度之间差异有统计学意义（P〈0．05）。【结论】中老年人无骨折脱位型颈髓损伤多伴有不同程度的颈椎退变，应根据患者临床症状轻重、影像学检查、患者全身情况等综合因素采用不同的“个体化”治疗方法，可取得令人满意的疗效但应注意术后并发症的预防和处理。

Therapeutic strategy and treatment of complications for cervical spinal cord injury without fracture and dislocation in old and middle-aged patients

[Objective] To investigate the therapic strategy and treatment of complications for cervical spinal cord injury without fracture and dislocation in old and middle-aged patients. [Methods] A retrospective study was designed. Data of patients met the following demands were collected： 50 years of ages and above; admitted between Jan, 2003 to Dec, 2008; meeting the diagnosis of cervical spinal cord injury without fracture and dislocation; follow-up at least 6 months. Mechnism of injury,neurological function impairment,characteristics of imaging, methods of treatment and therapeutic effect were analyzed. [ Results]All cases were followed up for 8.6 months （6- 14months）.According to Frankel classification for spinal cord injury,there were obvious improvements in 4 cases from Grade A to B,12 cases from Grade B to C or D,11 cases from Grade C to D or E,6 cases from Grade D to E. The ASIA （Amerian Spinal Injury Association） scores amplification before and after treatment differed significantly between operation group and non-operation group （P〈0.05）, and the same was between the two posterior-approach groups （P〈 0.05）. [Conclusions] The cervical spinal cord injuries without fracture and dislocation in old and middle-aged patients are often complicated with cervical cataplasia at different levels, various ＂individualized methods＂ should be taken to treat the injuries according to the degrees of clinical symptom, imaging reflect,body conditions of patients and so on. Although the satisfactory therapeutic effect is obtainable, more concerns should be paid to the prevention and treatment of postoperative complications.