CAJ | 학술논문

目的观察应用显微外科技术治疗外伤致脊髓型颈椎病患者脊髓损伤的疗效,探讨对影像学重度压迫的脊髓型颈椎病预防性手术的必要性.方法 2003年2月至2006年3月,对23例因外伤致脊髓刑颈椎病患者脊髓损伤采用颈前路、后路及前后联合入路手术治疗,术前及术后1～2年采用JOA脊髓功能评分和影像学评估,评价手术效果. 结果 20例患者术后症状即刻改善;3例于术后3个月内症状改善,其中2例术后神经症状短时间加重,1例于术后1周后恢复,另1例术后3周恢复(但其左上肢肌力未达到术前水平).按JOA 17分法评分,术前平均(6.67±2.35)分,术后平均(13.86±1.11)分,术前与术后12个月JOA评分差异有统计学意义(t=-15.100,P＜0.05),平均改善率为69.16%.影像学证实减压充分,椎体间植骨均愈合良好,23例患者均较满意. 结论脊髓型颈椎病患者遭受外力致脊髓损伤后应尽早手术,可获得良好效果.椎管受压面积超过50%以上,尽管临床症状体征表现较轻,亦应尽早行预防性手术治疗,以防止受外力刺激突然加重导致瘫痪的严重后果.
목적 관찰응용현미외과기술치료외상치척수형경추병환자척수손상적료효,탐토대영상학중도압박적척수형경추병예방성수술적필요성.방법 2003년2월지2006년3월,대23례인외상치척수형경추병환자척수손상채용경전로、후로급전후연합입로수술치료,술전급술후1～2년채용JOA척수공능평분화영상학평고,평개수술효과. 결과 20례환자술후증상즉각개선;3례우술후3개월내증상개선,기중2례술후신경증상단시간가중,1례우술후1주후회복,령1례술후3주회복(단기좌상지기력미체도술전수평).안JOA 17분법평분,술전평균(6.67±2.35)분,술후평균(13.86±1.11)분,술전여술후12개월JOA평분차이유통계학의의(t=-15.100,P＜0.05),평균개선솔위69.16%.영상학증실감압충분,추체간식골균유합량호,23례환자균교만의. 결론 척수형경추병환자조수외력치척수손상후응진조수술,가획득량호효과.추관수압면적초과50%이상,진관림상증상체정표현교경,역응진조행예방성수술치료,이방지수외력자격돌연가중도치탄탄적엄중후과.
Objective To analyze the clinical results of microanrgery for cervical spondylotic myelopathy (CSM) complicated with trauma by an anterior or posterior approach. Methods From February 2003 to March 2006, 23 patients with traumatic CSM were subjected to microsurgery through an ante-rior, posterior or combined approach. They were followed up for 1 to 2 years. Their spinal functions and the surgical effects were evaluated by pre & post-operative JOA scores and cervical images. Results Twenty patients got improved instantly after operation. Three patients were improved in 3 months. The neural symp-toms became a little worse after surgery in 2 patients, one of whom recovered in a week and the other recovered in 3 weeks but did not restore the muscle strength of the left upper limb. According to the JOA scores, the average rate of improvement was 69. 16%. The images indicated that their spinal cord was decompressed completely and all the intervertebral grafts got fine union. Conclusions Patients with traumatic CSM should be given surgery as soon as possible to secure fine effects. When more than 50% of the vertebral canal is compressed, prophylactic surgery should be taken to prevent palsy, even though the clinical symptoms and physical signs are mild.