CAJ | 학술논문

目的探讨脊髓型颈椎病前路手术引起脊髓损伤的原因和防治策略.方法分析2001年-2009年共749例实施前路减压融合手术的脊髓型颈椎病患者病历资料.共有5例患者在术后即刻或术后早期出现了脊髓功能下降.其中男3例,女2例;年龄48-62岁,平均52岁.2例合并有后纵韧带骨化.术前日本骨科学会(JOA)评分9-16分,平均12.4分.手术方式采用前路经颈椎间盘或椎体次全切除减压、自体髂骨或Cage融合、钛合金板内固定术.术中出血50～200 ml.2例患者术后即刻发现脊髓功能障碍加重,1例术后6 h出现下肢感觉运动消失,1例术后24 h出现一侧肢体瘫痪,1例术后5 d出现四肢麻木加重.4例患者早期给予大剂量甲基强的松龙冲击治疗.5例患者均再次行颈椎前路探查术,其中1例患者同时又行后路单开门椎管扩大成形术.结果随访时间1～2年,平均16个月.4例患者脊髓功能(JOA评分)术后3个月均恢复或优于术前水平,术后1年均优于术前水平;1例患者术后1年神经功能仍无改善.分析脊髓损伤原因:术中减压和止血伤及脊髓2例,减压不彻底1例,血肿和止血纱布压迫各1例.结论颈前路减压手术引起脊髓损伤的主要原因是术后延迟损伤,如果发现和处理及时,脊髓功能大多数可以恢复至术前水平.应尽量避免术中操作伤及脊髓,从而导致脊髓功能永久性障碍.
목적 탐토척수형경추병전로수술인기척수손상적원인화방치책략.방법 분석2001년-2009년공749례실시전로감압융합수술적척수형경추병환자병력자료.공유5례환자재술후즉각혹술후조기출현료척수공능하강.기중남3례,녀2례;년령48-62세,평균52세.2례합병유후종인대골화.술전일본골과학회(JOA)평분9-16분,평균12.4분.수술방식채용전로경경추간반혹추체차전절제감압、자체가골혹Cage융합、태합금판내고정술.술중출혈50～200 ml.2례환자술후즉각발현척수공능장애가중,1례술후6 h출현하지감각운동소실,1례술후24 h출현일측지체탄탄,1례술후5 d출현사지마목가중.4례환자조기급여대제량갑기강적송룡충격치료.5례환자균재차행경추전로탐사술,기중1례환자동시우행후로단개문추관확대성형술.결과 수방시간1～2년,평균16개월.4례환자척수공능(JOA평분)술후3개월균회복혹우우술전수평,술후1년균우우술전수평;1례환자술후1년신경공능잉무개선.분석척수손상원인:술중감압화지혈상급척수2례,감압불철저1례,혈종화지혈사포압박각1례.결론 경전로감압수술인기척수손상적주요원인시술후연지손상,여과발현화처리급시,척수공능대다수가이회복지술전수평.응진량피면술중조작상급척수,종이도치척수공능영구성장애.
Objective To investigate the causes and prevention strategies of postoperative spinal cord injury after anterior approach surgery for cervical spondylotic myelopathy. Methods The clinical data of 749 patients with cervical spondylotic myelopathy treated with anterior approach surgery from 2001 to 2009 were retrospectively studied.There were five patients with spinal cord dysfunction instantly or early after operation,including three males and two females at average age of 52 years (range,48-62 years).Two patients were combined with ossification of the posterior longitudinal ligament.The Japanese Orthopaedic Association (JOA) score was average 12.4(9-16)preoperatively.The surgeries included anterior cervical diskectomy(or corpectomy)and interbody fusion(iliac bone graft or cage or titanium mesh)and locking plates fixation.The blood loss was 50-200 ml.The symptoms included instant spinal cord injury in two patients,loss of the motor and feeling of both legs at 6 h after surgery in one,paralysis of one side limbs at 24 h after surgery in one and numbness of limbs at 5 days after surgery in one.Four patients were treated by large dose of methylprednisolone.Five patients underwent anterior exploration surgery,of which one patient received posterior cervical one-door expansive laminoplasty. Results The patients were followed up for average 16 months(12-24 months).The JOA score of four patients was recovered at three months and WaS better than preoperation after surgery.The function of spinal cord of one patient showed no improvement at one year after surgery.The causes for spinal cord injury included inappropriate surgical manipulation in decompression and haemostasis in two patients,insufficient decompression in one,epidural hematoma in one and absorbable hemostatic gauze in one. Conclusions The major causes of postoperative spinal cord injury in anterior approach surgery for cervical spondylofic myelopathy are the delayed postoperative injury.The spinal cord can recover to normal and has satisfactory prognosis if discovered promptly.We must avoid the spinal cord injury by surgical Manipulation that may result in permanent neurological deficits.