中国临床康复
中國臨床康複
중국림상강복
CHINESE JOURNAL OF CLINICAL REHABILITATION
2006年
5期
161-163
,共3页
张少成%马玉海%许硕贵%柳顺发%张秋林%逄育
張少成%馬玉海%許碩貴%柳順髮%張鞦林%逄育
장소성%마옥해%허석귀%류순발%장추림%방육
脊髓损伤%移植%显微外科手术%功能恢复
脊髓損傷%移植%顯微外科手術%功能恢複
척수손상%이식%현미외과수술%공능회복
背景:临床上常可发现,脊髓损伤患者在排除了脊髓压迫与不稳定等因素外,许多影像学改变极为相似的患者其感觉运动功能的恢复程度差别却很大.研究表明为硬脊膜内的粘连、纤维索条的牵拉、脊髓本身的创伤后瘢痕化、软化、囊肿所致. 目的:观察脊髓减压松解、神经组织植入治疗对陈旧性脊髓不完全性断裂伤的临床效果. ,设计:患者自身前后对照观察.对象:选择1994-06/2002-08解放军第二军医大学长海医院骨科外伤性陈旧性不完全瘫痪患者16例.损伤平面T7～9 5例,T10～12 7例,L1,2 4例.16例患者均曾于伤时行脊柱减压内固定,4例后路手术患者于本次手术前已取出内固定.6例患者曾针对外伤性不完全瘫痪进行过高压氧等治疗.有尿便功能障碍11例;神经根性疼痛4例.按Frankel分级:B级12例,C级4例.单位:解放军第二军医大学长海医院骨科.方法:采用显微外科技术切开患者硬脊膜,将蛛网膜、软脊膜、齿状韧带、神经根起始段与脊髓的粘连及周围的纤维条索彻底解除.将被瘢痕缩紧段的脊髓行3～6个切口纵行切开、深0.1～0.2 mm、长度超过损伤节段;若发现脊髓内囊肿,则切开后吸出其中液体.然后,将自身腓肠神经用显微外科方法去除外膜、束膜,并剪开、使神经组织的质地、外观类似马尾组织,将其排列呈多条状、纵行植入已切开的脊髓处或原囊肿腔内,用9-0的无损伤线与软脊膜适当固定.最后用外科防粘连膜和骶棘肌瓣覆盖.主要观察指标:患者术后感觉和运动及尿便功能恢复情况.结果:16例患者平均随访2.5年,均进入结果分析.所有患者感觉和运动均增加1级以上,11例术前有尿便功能障碍者症状明显改善,其中6例按Frankel肌力分级,双下肢主要肌群肌力术后较术前增加2级以上,达4级,恢复行走能力,10例增加1级.结论:解除硬脊膜内粘连,瘢痕段脊髓切开,自体周围神经组织植入桥接,可以明显改善外伤性陈旧性不完全瘫痪患者的尿便功能并恢复其部分感觉运动功能.
揹景:臨床上常可髮現,脊髓損傷患者在排除瞭脊髓壓迫與不穩定等因素外,許多影像學改變極為相似的患者其感覺運動功能的恢複程度差彆卻很大.研究錶明為硬脊膜內的粘連、纖維索條的牽拉、脊髓本身的創傷後瘢痕化、軟化、囊腫所緻. 目的:觀察脊髓減壓鬆解、神經組織植入治療對陳舊性脊髓不完全性斷裂傷的臨床效果. ,設計:患者自身前後對照觀察.對象:選擇1994-06/2002-08解放軍第二軍醫大學長海醫院骨科外傷性陳舊性不完全癱瘓患者16例.損傷平麵T7～9 5例,T10～12 7例,L1,2 4例.16例患者均曾于傷時行脊柱減壓內固定,4例後路手術患者于本次手術前已取齣內固定.6例患者曾針對外傷性不完全癱瘓進行過高壓氧等治療.有尿便功能障礙11例;神經根性疼痛4例.按Frankel分級:B級12例,C級4例.單位:解放軍第二軍醫大學長海醫院骨科.方法:採用顯微外科技術切開患者硬脊膜,將蛛網膜、軟脊膜、齒狀韌帶、神經根起始段與脊髓的粘連及週圍的纖維條索徹底解除.將被瘢痕縮緊段的脊髓行3～6箇切口縱行切開、深0.1～0.2 mm、長度超過損傷節段;若髮現脊髓內囊腫,則切開後吸齣其中液體.然後,將自身腓腸神經用顯微外科方法去除外膜、束膜,併剪開、使神經組織的質地、外觀類似馬尾組織,將其排列呈多條狀、縱行植入已切開的脊髓處或原囊腫腔內,用9-0的無損傷線與軟脊膜適噹固定.最後用外科防粘連膜和骶棘肌瓣覆蓋.主要觀察指標:患者術後感覺和運動及尿便功能恢複情況.結果:16例患者平均隨訪2.5年,均進入結果分析.所有患者感覺和運動均增加1級以上,11例術前有尿便功能障礙者癥狀明顯改善,其中6例按Frankel肌力分級,雙下肢主要肌群肌力術後較術前增加2級以上,達4級,恢複行走能力,10例增加1級.結論:解除硬脊膜內粘連,瘢痕段脊髓切開,自體週圍神經組織植入橋接,可以明顯改善外傷性陳舊性不完全癱瘓患者的尿便功能併恢複其部分感覺運動功能.
배경:림상상상가발현,척수손상환자재배제료척수압박여불은정등인소외,허다영상학개변겁위상사적환자기감각운동공능적회복정도차별각흔대.연구표명위경척막내적점련、섬유색조적견랍、척수본신적창상후반흔화、연화、낭종소치. 목적:관찰척수감압송해、신경조직식입치료대진구성척수불완전성단렬상적림상효과. ,설계:환자자신전후대조관찰.대상:선택1994-06/2002-08해방군제이군의대학장해의원골과외상성진구성불완전탄탄환자16례.손상평면T7～9 5례,T10～12 7례,L1,2 4례.16례환자균증우상시행척주감압내고정,4례후로수술환자우본차수술전이취출내고정.6례환자증침대외상성불완전탄탄진행과고압양등치료.유뇨편공능장애11례;신경근성동통4례.안Frankel분급:B급12례,C급4례.단위:해방군제이군의대학장해의원골과.방법:채용현미외과기술절개환자경척막,장주망막、연척막、치상인대、신경근기시단여척수적점련급주위적섬유조색철저해제.장피반흔축긴단적척수행3～6개절구종행절개、심0.1～0.2 mm、장도초과손상절단;약발현척수내낭종,칙절개후흡출기중액체.연후,장자신비장신경용현미외과방법거제외막、속막,병전개、사신경조직적질지、외관유사마미조직,장기배렬정다조상、종행식입이절개적척수처혹원낭종강내,용9-0적무손상선여연척막괄당고정.최후용외과방점련막화저극기판복개.주요관찰지표:환자술후감각화운동급뇨편공능회복정황.결과:16례환자평균수방2.5년,균진입결과분석.소유환자감각화운동균증가1급이상,11례술전유뇨편공능장애자증상명현개선,기중6례안Frankel기력분급,쌍하지주요기군기력술후교술전증가2급이상,체4급,회복행주능력,10례증가1급.결론:해제경척막내점련,반흔단척수절개,자체주위신경조직식입교접,가이명현개선외상성진구성불완전탄탄환자적뇨편공능병회복기부분감각운동공능.
BACKGROUND: It is often found in the clinic that apart from oppression and instability, there is much difference in sensibility and motion function recovery in patients who have similar imageological changes. Studies show that adhesion in the dura mater of spinal cord, traction of fibrous strip,traumatic scar, malacosis and cyst are the main causes.OBJECTIVE: To investigate the clinical effects of spinal decompression and nerve tissue implantation for obsolete incomplete paralysis.DESIGN: Self-control observation.SETTING: Department of Orthopaedics, Changhai Hospital of Second Military Medical University of Chinese PLA.PARTICIPANTS: We selected 28 patients with traumatic obsolete incom plete paralysis from the Department of Orthopaedics, Changhai Hospital of Second Military Medical University of Chinese PLA, from June 1994 to August 2002. Injured vertebral segments were T7-T9 (5 cases), T10-T12 (12 cases), and L1-2(11 cases). Sixteen patients had undergone decompression, fusion and internal fixation. Thirteen cases of them had undergone posterior decompression and pedicle screw internal fixation. The internal fixation devices had been removed in 7 patients before this procedure. Six cases of traumatic obsolete incomplete paralysis had been treated by hyperbaric oxygen. According to the classification of Frankel, 16 cases were degree B and 12 cases were degree C.METHODS: The dura mater of spinal cord was opened, and the fibrous bands adhering to the spinal cord from arachnoid, pia mater spinalis, ligamenta denticulatum, initial part of nerve root were complete relieved. Then the spinal cord with scar fibers contracted was opened by 3-6 incisions,which were 0.1-0.2 mm deep and longer than the scar part. Cyst found in the spinal cord in 6 cases was opened and the liquid in it was sucked. After that, we denuded spineurium and perineurium of the autogenous sural nerve graft, making the texture and appearance of the nerve look like cauda equine. The nerve was lined in several strips and longitudinally implanted into the incised spinal cord and cyst, and then it was sutured with pia mater spinalis with 9-0 scatheless wire. Finally the endorachis was sutured or covered by sacrospinal muscle.RESULTS: Sixteen cases were followed up for an average of 2.5 years, and all the patients entered the result analysis. The sensibility and motion func tion increased above one grade. Eleven patients who had suffered gatism had obvious progress. The strength of main muscle was increased by 2 grades and reached grade 4 in 16 cases, and walking capability was recovered. In 10 cases it was increased by 1 grade Only sensation had progress in 2 cases.CONCLUSION: Relieving adhesion in the endorhachis, incising the cicatricial spinal cord and bridging the autogenous peripheral nerve have good therapeutic results for gatism and recovering the muscle power of the ex-tremities for the patients with traumatic obsolete incomplete paralysis.
