CAJ | 학술논문

目的探讨颈椎过伸性脊髓损伤的手术干预时机对手术疗效及手功能恢复的影响.方法 2005年2月至2009年8月共收治34例颈椎过伸性损伤患者,根据接受手术的时间分为3组:1～6 d手术组(17例)、6～14 d手术组(10例)、14 d以后手术组(7例),比较3组手术前、后美国脊髓损伤协会(ASIA)运动评分改变,并分析手术前、后手内在肌功能改善情况.结果 34例患者术后获12～40个月(平均18个月)随访.ASAI运动评分:术后1个月和末次随防总的功能改善率1～6 d手术组优于6～14 d手术组和14 d以后手术组,差异有统计学意义(P＜0.05),6～14 d手术组与14 d以后手术组无明显差异.手内在肌功能改善率1个月内3组间差异无统计学意义(P=0.101);末次随访时1～6 d手术组优于6～14 d手术组及14 d以后手术组,差异有统计学意义(P＜0.05),6～14 d手术组与14 d以后手术组无明显差异.结论颈椎过伸性损伤应该在伤后6 d内手术,尽早减压是最大限度恢复神经功能、减少相关并发症的关键.手术干预时机对手运动神经功能短期恢复无明显影响,但对远期恢复有明显影响.
목적 탐토경추과신성척수손상적수술간예시궤대수술료효급수공능회복적영향.방법 2005년2월지2009년8월공수치34례경추과신성손상환자,근거접수수술적시간분위3조:1～6 d수술조(17례)、6～14 d수술조(10례)、14 d이후수술조(7례),비교3조수술전、후미국척수손상협회(ASIA)운동평분개변,병분석수술전、후수내재기공능개선정황.결과 34례환자술후획12～40개월(평균18개월)수방.ASAI운동평분:술후1개월화말차수방총적공능개선솔1～6 d수술조우우6～14 d수술조화14 d이후수술조,차이유통계학의의(P＜0.05),6～14 d수술조여14 d이후수술조무명현차이.수내재기공능개선솔1개월내3조간차이무통계학의의(P=0.101);말차수방시1～6 d수술조우우6～14 d수술조급14 d이후수술조,차이유통계학의의(P＜0.05),6～14 d수술조여14 d이후수술조무명현차이.결론 경추과신성손상응해재상후6 d내수술,진조감압시최대한도회복신경공능、감소상관병발증적관건.수술간예시궤대수운동신경공능단기회복무명현영향,단대원기회복유명현영향.
Objective To determine the correlations between the time of surgical intervention, effect of surgery and functional recovery of the hand in the treatment of hyperextension injury to the cervical spinal cord. Methods We treated 34 cases of cervical hyperextension injury from February 2005 to August 2009. According to the time of surgical intervention, they were classified into 3 groups. In group A, 17 cases received operation within 6 days, in group B 10 cases had operation from 6 to 14 days, and in group C, 7 cases had operation after 14 days. The 3 groups were compared respectively in terms of their preoperative and postoperative American Spinal Injury Association (ASIA) motor scores and their functional recovery of the hands' intrinsic muscle. Results They were followed up for 12 to 40 months. By ASIA scores for spinal nerve function, group A was significantly better than groups B ( P =0. 025) and C ( P =0. 042) in one month and at the last follow-up after operation but there was no significant difference between group B and C ( P =0. 849) . In strength of the intrinsic muscle in one month after operation, there was no significant difference (P = 0. 101 ) between the 3 groups. In the neural function at the last follow-up, group A was significantly better than group B ( P = 0. 034) and group C ( P = 0. 006), but there was no significant difference ( P =0. 217) between groups B and C, Conclusions Patients with hyperextension injury to the cervical spinal cord should be operated on within 6 days after injury. Early operative decompression is the key to nerve functional recovery and reduction of associated complications. The short-term functional recovery of the hand intrinsic muscle may have no obvious relation to the time of surgical intervention but the long-term recovery may be obviously related to the operative time.