中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (22): 4135-4138.doi: 10.3969/j.issn.1673-8225.2010.22.037

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

无骨折脱位型颈脊髓损伤3种金属置入物疗效观察

詹  翼1，2，吴增晖1，章  凯1，马向阳1，麦晓红1   

  1. 1解放军广州军区广州总医院脊柱外科，广东省广州市  510010；2广州医学院，广东省广州市  510010
  • 出版日期:2010-05-28 发布日期:2010-05-28
  • 作者简介:詹 翼★，男，1981年生，湖南省衡阳市人，汉族，2010年广州医学院毕业，硕士，医师，主要从事脊柱外科基础与临床的研究。 zhanyi172@126.com

Curative effect of cervical spinal cord injury without fracture or dislocation using three surgical methods

Zhan Yi 1, 2, Wu Zeng-hui1, Zhang Kai1, Ma Xiang-yang1, Mai Xiao-hong1   

  1. 1 Department of Orthopaedic Surgery, Guangzhou General Hospital, Guangzhou Military Command, Guangzhou  510010, Guangdong Province, China; 2 Guangzhou Medical University, Guangzhou  510010, Guangdong Province, China
  • Online:2010-05-28 Published:2010-05-28
  • About author:Zhan Yi★, Master, Physician, Department of Orthopaedic Surgery, Guangzhou General Hospital, Guangzhou Military Command, Guangzhou 510010, Guangdong Province, China; Guangzhou Medical University, Guangzhou 510010, Guangdong Province, China zhanyi172@126.com

PDF

392

被引次数

3

摘要：

背景：近年来，随着解剖学、影像学、外科技术的发展及国内外学者研究的深入，无骨折脱位型颈脊髓损伤的相关治疗取得了长足进步。
目的：观察前路重建脊柱稳定、后路减压+侧块固定、前路重建脊柱稳定+后路减压治疗无骨折脱位型颈脊髓损伤的效果。
方法：回顾性分析2003-10/2005-12解放军广州军区广州总医院脊柱外科收治的无骨折脱位型颈脊髓损伤患者27例，男22例，女5例，均伤后7 d内入院，并行手术治疗。根据患者的损伤情况采用3种方式，前路减压重建脊柱稳定，后路单开门+侧块固定，前路重建脊柱稳定+后路减压。疗效评价标准采用Frankel分级及JOA评分计算改善率。
结果与结论：全部患者均获得随访，随访时间6~33个月，平均18个月。影像学复查提示减压充分，内固定固定良好，未见松动滑脱、断裂等现象，融合节段1年后均获得良好骨性融合。27例患者出院时神经系统症状均有不同程度改善。除1例Frankel A级患者无明显恢复外，其余均恢复1~4级。置入后JOA评分较置入前有明显改善，其中前路减压重建脊柱稳定组改善率为50%，后路单开门+侧块固定组改善率为53%，前路重建脊柱稳定+后路减压组改善率为51%。所有病例置入中未出现血管、神经损伤等并发症，随访中亦无并发症发生。提示根据无骨折脱位型颈脊髓损伤的不同特点，采取合理方式，可获得较好疗效。

关键词: 颈椎, 脊髓损伤, 无骨折脱位, 外科治疗, 硬组织植入物

Abstract:

BACKGROUND: In recent years, the development of anatomy, imaging, surgical technology and the deepening understanding of studies significantly improve the treatment of cervical spinal cord injury without fracture or dislocation (CSCIWFD).
OBJECTIVE: To observe effect of anterior reconstruction of spinal stability, posterior decompression and lateral mass fixation, anterior decompression and posterior reconstruction of spinal stability for treatment of CSCIWFD.
METHODS: A total of 27 CSCIWFD patients from the General Hospital of Guangzhou Military Command between October 2003 and December 2005 were retrospectively analyzed, including 22 males and 5 females, who were admitted to hospital within 7 days after injury and treated by anterior decompression and reconstruction of spinal stability, single-door and posterior lateral mass fixation, anterior decompression and posterior reconstruction of spinal stability according to their damage. Treatment effect was evaluated by Frankel grading, and improvement rate was calculated by JOA score.
RESULTS AND CONCLUSION: All patients were followed up for 6 to 33 months, with an average of 18 months. Imaging results showed full decompression, well fixed internal fixation, no loosening or fracture phenomena. In addition, fusion segments were well after 1 year of bone fusion. The neurological symptoms of 27 patients were improved when they were discharged. Except one case of Frankel A with no significant recovery, the remainders were 1 to 4. Postoperative JOA score was significantly improved compared with the preoperative: the anterior decompression and reconstruction of spinal stability group was improved by 50%, posterior lateral mass of a single door and fixed group by 53%, anterior and posterior reconstruction of spinal stability by pressure group by 51%. All patients did not develop complications in blood vessels or nerve injury during implantation or follow-up. Results show that appropriate surgical procedure can obtain good effect according to features of CSCIWFD.

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