成人无骨折脱位型颈脊髓损伤早期手术的疗效

doi:10.3877/cma.j.issn.2095-9141.2021.01.010

目的

评价成人无骨折脱位型颈部脊髓损伤（CSCIWORA）早期手术治疗效果。

方法

回顾性分析联勤保障部队第九二〇医院神经外科自2014年5月至2018年10月收治的37例成人急性CSCIWORA患者，按照治疗方式将其分为手术组（25例）和保守组（12例），其中手术组采用经椎板减压和内固定术，保守组采用保守治疗。根据美国脊髓损伤协会（ASIA）标准对脊髓功能进行评分，术后随访6、12、24个月评估2组患者脊髓功能恢复情况。

结果

25例手术患者均无严重并发症，干预后6、12、24个月，手术组的ASIA运动评分均较高于保守组，差异有统计学意义（P<0.05），且半年内ASIA运动评分恢复较快，半年后恢复明显放缓。

结论

对无骨折脱位型颈脊髓进行早期充分的减压和固定，可以促进颈脊髓功能早期恢复并改善长期疗效。

关键词: 无骨折脱位型颈脊髓损伤, 美国脊髓损伤协会运动评分, 脊髓损伤分级, 成人

Objective

To evaluate the effect of early surgical treatment for cervical spinal cord injury without radiographic abnormalities (CSCIWORA) in adults.

Methods

Thirty-seven adult CSCIWORA patients treated in Neurosurgery Department of 920^th Hospital of Joint Logistics Support Force from May 2014 to October 2018 were retrospectively analyzed. According to the treatment methods, they were divided into operation group (25 cases) and conservative group (12 cases). The operation group was treated with laminectomy and internal fixation, and the conservative group was treated with conservative treatment. According to the American Spinal Cord Injury Association (ASIA) standard, the spinal cord function of the two groups was scored. The patients were followed up for 6, 12 and 24 months to evaluate the recovery of spinal cord function.

Results

There were no serious complications in the 25 patients. After 6, 12 and 24 months of intervention, the ASIA motor score of the operation group was higher than that of the conservative group, and the difference was statistically significant (P<0.05). The ASIA motor score recovered faster in half a year, and slowed down significantly after half a year.

Conclusion

Early decompression and fixation can promote the early recovery of cervical spinal cord function and improve the long-term effect.

Key words: Cervical spinal cord injury without radiographic abnormalities, American Spinal Cord Injury Association motor score, American Spinal Cord Injury Association impairment scale, Adults

表1 2组患者治疗前后AIS分级情况[例（%）]

组别	时间	B级	C级	D级	E级
手术组(n=25)	治疗前	1(4)	16(64)	8(32)	0
	治疗后6个月	0	6(24)	8(32)	11(44)
	治疗后12个月	0	3(12)	5(20)	17(68)
	治疗后24个月	0	1(4)	6(24)	18(72)
保守组(n=12)	治疗前	0	7(58.3)	5(41.7)	0
	治疗后6个月	0	6(50.0)	5(41.7)	1(8.3)
	治疗后12个月	0	4(33.3)	7(58.3)	1(8.3)
	治疗后24个月	0	3(25.0)	8(66.7)	1(8.3)

表1 2组患者治疗前后AIS分级情况[例（%）]

组别	时间	B级	C级	D级	E级
手术组(n=25)	治疗前	1(4)	16(64)	8(32)	0
	治疗后6个月	0	6(24)	8(32)	11(44)
	治疗后12个月	0	3(12)	5(20)	17(68)
	治疗后24个月	0	1(4)	6(24)	18(72)
保守组(n=12)	治疗前	0	7(58.3)	5(41.7)	0
	治疗后6个月	0	6(50.0)	5(41.7)	1(8.3)
	治疗后12个月	0	4(33.3)	7(58.3)	1(8.3)
	治疗后24个月	0	3(25.0)	8(66.7)	1(8.3)

图1 2组治疗前后美国脊髓损伤协会运动评分变化

表2 2组患者治疗前后ASIA运动评分比较

组别	例数	治疗前	治疗后6个月	治疗后12个月	治疗后24个月	F值	P值
手术组	25	42.56±17.96	83.04±21.62^a	90.84±16.06^a	93.68±12.17^ab	42.223	<0.001
保守组	12	43.63±11.54	64.72±23.37^a	67.27±22.35^a	68.36±20.93^a	3.527	0.024
t值		-0.178	2.274	3.475	3.580
P值		0.860	0.029	0.001	0.003

表2 2组患者治疗前后ASIA运动评分比较

组别	例数	治疗前	治疗后6个月	治疗后12个月	治疗后24个月	F值	P值
手术组	25	42.56±17.96	83.04±21.62^a	90.84±16.06^a	93.68±12.17^ab	42.223	<0.001
保守组	12	43.63±11.54	64.72±23.37^a	67.27±22.35^a	68.36±20.93^a	3.527	0.024
t值		-0.178	2.274	3.475	3.580
P值		0.860	0.029	0.001	0.003

图2 无骨折脱位型颈髓损伤患者术前术后影像学资料

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Early surgical treatment of cervical spinal cord injury without radiographic abnormalities in adults

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Early surgical treatment of cervical spinal cord injury without radiographic abnormalities in adults