高位颈髓压迫症的外科治疗

目的: 探讨高位颈髓压迫症的外科治疗。方法: 高位颈髓压迫症 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, 类风湿性关节炎 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 49例, 肿瘤 4例。根据复位情况及脊髓受压部位选择不同的术式, 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. Method: Two hundred and twenty eight patients with high spinal cord compression, the causes of the compression were 58 cases of odontoid fracture (38 cases with fresh fractures, 20 cases with old fractures), 45 cases of Hangman fracture (28 cases with fresh fractures, 17 cases with old fractures) , 24 cases of torn transverse ligament of atlas, 19 cases of unilateral fracture of 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, 49 cases of congenital deformity, 4 cases of spinal tumor. Different operative methods were confirmed according as diaplasis and orientation of spinal cord compression, and reconstruction of spinal stability. Result: With an average follow up of 4 years and 11 months, average JOA grade were 7.5 preoperation, and were 14.9 at follow up, improve rate were 79.9%. Conclusion: Plenitude decompression is key method for maximum improvement of the nerve function, spinal stability reconstruction is greatly necessary.