无骨折脱位型颈髓损伤解剖机制与治疗方式选择的探讨

目的探讨成人无骨折脱位型颈髓损伤解剖机制与治疗方式选择。方法通过回顾性病例对照研究,对我们医院2000～2009年43例无骨折脱位型颈脊髓损伤患者的临床资料进行分析。资料分为两组:A组为非手术组,共15例;B组为手术治疗组,共28例。A组又分为A1组:颈椎管内无压迫、椎管矢状径正常者,6例;A2组:颈椎管内存在致压,矢状径15mm者,9例。B组分为B1组:颈椎管内无压迫、椎管矢状径≥15mm者,共7例;B2组:颈椎管内存在致压,矢状径小于正常范围者,共21例。比较、A1与B1组、B1与B2组、A2与B2组之间在治疗前后JOA评分。结果各组在治疗后感觉及运动功能均较治疗前有明显提高(P0.05);B组(手术组)疗效明显优于A组(非手术组)(P0.05)。但A1与B1组、B1与B2组疗效的差异无统计学意义(P0.05);B2组的疗效明显优于A2组(P0.05);A1组的疗效明显优于A2组(P0.05)。结论对无骨折脱位型颈脊髓损伤,应根据受伤机制及影像学检查,有针对性地选择治疗方式,可以获得较好的临床结果。

Anatomic mechanism and therapeutic choice for the dislocated cervical cord injury without fracture

Objective　To investigate anatomic mechanism and therapeutic choice for the dislocated cervical cord injury without fracture.　Methods　A retrospective case-control study in our hospital from 2000 to 2009 with 43 cases of the dislocated cervical cord injury without fracture was performed. 43 patients were divided into group A (15 cases), treated with drugs and physical method, and group B (28 cases), treated with surgical operation. Group A was further divided into A1(6 cases)， with no compression of cervical spine and the normal spinal sagittal diameter; A2 (9 cases), with the compression of cervical canal, and the sagittal diameter <15 mm. Group B was further divided into B1 (7 cases), with no compression of the cervical spine, and the spinal sagittal diameter ≥ 15 mm; B2 (21 cases), with the compression of cervical canal, and the sagittal diameter less than the normal range. The JOA score were compared between A1 and B1, B1 and B2, A2 and B2 before and after the treatment respectively.　Results　For all patients, both sensory and motor functions improved significantly after the treatment (P<0.05). The therapy effects of group B was better than that of group A (P <0.05). However, there were no difference of JOA scores appeared between A1 and B1, B1 and B2 (P> 0.05). Group B2 was better than the effects of A2 (P<0.05), and A1 was better than that of A2 (P< 0.05). Conclusions　For treatment of the dislocated cervical cord injury without fracture, the individual therapeutic choice should be considered according to the injury mechanism and the results of imaging examination.