老年无骨折脱位型颈脊髓损伤的诊治及围手术期管理

目的分析老年无骨折脱位型颈脊髓损伤的成因及损伤机制,探讨MRI表现、治疗方法选择,并对围手术期管理提出指导。方法回顾2003年3月~2013年10月收治的〉60岁的无骨折脱位型颈脊髓损伤296例,对发生机制、伤后MRI片脊髓信号改变、治疗手段对神经恢复的影响进行分析,对伤后MRI上脊髓T2加权像高信号变化进行分型。结果 236例患者MRI T2加权像有信号变化,其中Ⅰ型125例、Ⅱ型79例、Ⅲ型27例、Ⅳ型5例。296例患者中,手术治疗222例,非手术治疗74例。2组神经功能恢复率有明显区别（P〈0.05）;且伤后早期（〈72 h）手术患者的症状改善率高于稍晚手术患者。伤后颈脊髓内MRI的T2加权像异常信号可以分为4型。结论老年颈脊髓损伤患者有明显神经损伤症状者应尽早手术治疗。患者术前应戒烟、行呼吸功能练习和体位训练,术后应早期离床活动,以促进神经功能恢复及减少并发症发生。

Diagnosis, treatment and perioperative management of elderly cervical spinal cord injury without fracture and dislocation

Objective To analyze the cause and the injury mechanism of the elderly cervical spinal cord injury without fracture and dislocation （CSCIWFD）, to discuss the MRI characteristics and therapeutic method, and to provide the guidance for the perioperative management. Methods A total of 296 CSCIWFD cases （ more than 60 years old） treated from March 2003 to October 2013 were involved in this study. The pathogenesis, the spinal cord signal changes on MRI, and the neuro- logical therapeutic outcomes of CSCIWFD were analyzed retrospectively. Results Of all patients, MRI T2WI signals of 236 cases were changed（ 125 cases of TypeⅠ ,79 cases of TypeⅡ, 27 cases of Type III, 5 cases of Type IV. Among 296 case, there were 222 cases in operation group and 74 eases in non-operation group. The neurological function recovery rate has sig- nificant difference between 2 groups （ P 〈 0.05 ）, and the symptomatic improvement rate of early stage surgical treatment （ 〈 72 h） was higher than late stage surgical treatment. Conclusion The elderly CSCIWFD patients with significant neurological symptoms should be treated by surgery as early as possible. They should quit smoke, carry out both breathing exercises and postural training before operation. In addition, postoperative early out of bed rehabilitative exercises contributes to not only the neurological function recovery but also the reduction of complications.