中华临床医师杂志（电子版）
中華臨床醫師雜誌（電子版）
중화림상의사잡지（전자판）
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2012年
13期
115-117
,共3页
胸椎%腰椎%脊髓损伤%硬脊膜
胸椎%腰椎%脊髓損傷%硬脊膜
흉추%요추%척수손상%경척막
Thoracic verebrae%Lumbar vertebrae%Spinal cord injuries%Dura mater
目的 探讨硬脊膜减张术在陈旧性胸腰段脊柱骨折合并脊髓损伤治疗中的应用意义.方法 68例已行减压及内固定手术的陈旧性胸腰段骨折合并脊髓损伤患者,术后遗留脊髓功能障碍按Frankel分级:A级14例,B级36例,C级12例,D级6例.男43例,女25例,年龄16 ～ 57岁,平均34.6岁.受伤至本次手术时间4～26个月,平均(13±2.6)个月.在因早期减压不彻底、内固定不理想等原因需要二次手术的过程中,在去除了外在黏连压迫后,发现硬脊膜增厚变硬经观察3～5 min仍无搏动的患者,随机分为2组.其中对照组(A组)34例患者行硬膜外瘢痕松解,对硬脊膜不做处理.硬膜减张组(B组)34例患者充分显露硬脊膜,选择发硬增厚明显的部位,用锐利刃片间断地行多排纵行长约1 cm的小切口,深度为仅次全切透硬脊膜而保留蛛网膜,至有少许脑脊液渗出而不溢流,硬脊膜膨胀并恢复搏动.结果 术后随访24个月至10年,平均为39个月.A组Frankel改善2级者4例；改善1级者7例,11例(32.4％)患者神经功能获得不同程度恢复,主要是感觉恢复；B组Frankel改善2级者12例；改善1级者11例,23例(67.6％)患者神经功能获得明显的恢复,感觉和运动功能均有所恢复；22例有明显的大小便功能恢复,两组之间差异具有统计学意义(P＜0.01).结论 硬脊膜减张术有助于提高陈旧性胸腰段脊柱骨折合并脊髓损伤患者的神经功能恢复,且简便易行.
目的 探討硬脊膜減張術在陳舊性胸腰段脊柱骨摺閤併脊髓損傷治療中的應用意義.方法 68例已行減壓及內固定手術的陳舊性胸腰段骨摺閤併脊髓損傷患者,術後遺留脊髓功能障礙按Frankel分級:A級14例,B級36例,C級12例,D級6例.男43例,女25例,年齡16 ～ 57歲,平均34.6歲.受傷至本次手術時間4～26箇月,平均(13±2.6)箇月.在因早期減壓不徹底、內固定不理想等原因需要二次手術的過程中,在去除瞭外在黏連壓迫後,髮現硬脊膜增厚變硬經觀察3～5 min仍無搏動的患者,隨機分為2組.其中對照組(A組)34例患者行硬膜外瘢痕鬆解,對硬脊膜不做處理.硬膜減張組(B組)34例患者充分顯露硬脊膜,選擇髮硬增厚明顯的部位,用銳利刃片間斷地行多排縱行長約1 cm的小切口,深度為僅次全切透硬脊膜而保留蛛網膜,至有少許腦脊液滲齣而不溢流,硬脊膜膨脹併恢複搏動.結果 術後隨訪24箇月至10年,平均為39箇月.A組Frankel改善2級者4例；改善1級者7例,11例(32.4％)患者神經功能穫得不同程度恢複,主要是感覺恢複；B組Frankel改善2級者12例；改善1級者11例,23例(67.6％)患者神經功能穫得明顯的恢複,感覺和運動功能均有所恢複；22例有明顯的大小便功能恢複,兩組之間差異具有統計學意義(P＜0.01).結論 硬脊膜減張術有助于提高陳舊性胸腰段脊柱骨摺閤併脊髓損傷患者的神經功能恢複,且簡便易行.
목적 탐토경척막감장술재진구성흉요단척주골절합병척수손상치료중적응용의의.방법 68례이행감압급내고정수술적진구성흉요단골절합병척수손상환자,술후유류척수공능장애안Frankel분급:A급14례,B급36례,C급12례,D급6례.남43례,녀25례,년령16 ～ 57세,평균34.6세.수상지본차수술시간4～26개월,평균(13±2.6)개월.재인조기감압불철저、내고정불이상등원인수요이차수술적과정중,재거제료외재점련압박후,발현경척막증후변경경관찰3～5 min잉무박동적환자,수궤분위2조.기중대조조(A조)34례환자행경막외반흔송해,대경척막불주처리.경막감장조(B조)34례환자충분현로경척막,선택발경증후명현적부위,용예리인편간단지행다배종행장약1 cm적소절구,심도위부차전절투경척막이보류주망막,지유소허뇌척액삼출이불일류,경척막팽창병회복박동.결과 술후수방24개월지10년,평균위39개월.A조Frankel개선2급자4례；개선1급자7례,11례(32.4％)환자신경공능획득불동정도회복,주요시감각회복；B조Frankel개선2급자12례；개선1급자11례,23례(67.6％)환자신경공능획득명현적회복,감각화운동공능균유소회복；22례유명현적대소편공능회복,량조지간차이구유통계학의의(P＜0.01).결론 경척막감장술유조우제고진구성흉요단척주골절합병척수손상환자적신경공능회복,차간편역행.
Objective To evaluate the results of delayed thoracohmbar fractures with spinal cord injury treated by dura mater netlike incisions decompression.Methods Sixty-eight patients of delayed thoracolumbar fractures with spinal cord injury were entered in the study,including 43 males and 25 females with an average of 34.6 years(range,16 to 57).A1ll patients had been treated with laminectomy and internal fixation and left with neurological dysfunction.The Frankel grade showed:grade A 14 cases,B in 36,C in 12,D in 6.The mean time from injury to the index operation was 13 months( range,4 to 26 ).Due to incompleted decompression or illed internal fixation,these cases need to be re-treated.After removing the scar outside the dura mater,all the patients whose dura mater were observed without throbing within 3-5 minutes,were randomly divided into two groups.In group A,34 cases were undergone only by scar removing from dura mater.In group B,the dura mater of 34 cases were fully revealed,then the thickening and hard parts were selected to be treated by decompression with netlike incisions until the throb of dura mater were resumed.The depth of incisions was only to dural without relating to CSF overflowing.Results All patients were followed up for average 39 months(range 24 months to 10 years).The neurological functional recovery rate was 67.6％ (23/34)in group B including Frankel grade improved 2 grade in 12 oases,1 grade 11.For group A,32.4％ (11/34) of cases recovered partially( sensory function) including Frankel grade improved 2 grade in 4 cases,1 grade 7.The statistics difference was significant between group A and group B,the same as to pre-operation and postoperation in group B.Partially functional recovery of urinate and cacation was found in 22 cases( 64.7％,22/34).Conclusions Dura mater decompression technique is a simple and easy way and has a positive effect to delayed thoracolumbar fractures with spinal cord injury.
