CAJ | 학술논문

目的探讨过伸性颈髓损伤合并颈椎间盘撕裂伤的诊断和前路手术治疗效果.方法回顾性分析27例过伸性颈髓损伤合并颈椎间盘撕裂伤患者的临床资料,对其年龄分布、临床表现、X线和MRI表现、术中椎问盘损伤情况进行分析.均采用颈椎前路椎间盘切除、椎体间植骨和内固定术,依据术前、术后Frankel分级情况,ASIA运动功能评分(AMS)和改善率评价治疗效果. 结果所有患者MRI、X线片均提示不同的病理改变,以椎前阴影增宽、椎前间隙增宽、椎间盘突出、脊髓压迫及水肿为突出特点.除1例Frankel A级患者神经功能无明显恢复外,其余患者术后均有1～3个等级的恢复.随访9～32个月,平均17.5个月.与入院时相比,术后2个月和末次随访时AMS明显增高,运动功能恢复率分别为44.9%和68.1%,差异有统计学意义.未见内置物松动、脱落或断裂等并发症,固定节段均获得骨件融合. 结论 MRI和X线检查是过伸性颈椎损伤合并椎间盘撕裂伤的重要诊断手段,一旦诊断明确应行颈椎前路手术治疗,可获得较理想的脊髓功能恢复.
목적 탐토과신성경수손상합병경추간반시렬상적진단화전로수술치료효과.방법 회고성분석27례과신성경수손상합병경추간반시렬상환자적림상자료,대기년령분포、림상표현、X선화MRI표현、술중추문반손상정황진행분석.균채용경추전로추간반절제、추체간식골화내고정술,의거술전、술후Frankel분급정황,ASIA운동공능평분(AMS)화개선솔평개치료효과. 결과 소유환자MRI、X선편균제시불동적병리개변,이추전음영증관、추전간극증관、추간반돌출、척수압박급수종위돌출특점.제1례Frankel A급환자신경공능무명현회복외,기여환자술후균유1～3개등급적회복.수방9～32개월,평균17.5개월.여입원시상비,술후2개월화말차수방시AMS명현증고,운동공능회복솔분별위44.9%화68.1%,차이유통계학의의.미견내치물송동、탈락혹단렬등병발증,고정절단균획득골건융합. 결론 MRI화X선검사시과신성경추손상합병추간반시렬상적중요진단수단,일단진단명학응행경추전로수술치료,가획득교이상적척수공능회복.
Objective To discuss diagnosis and anterior surgical treatment of hyperextensian cervical spine injury combined with intervertebral disk injury. Methods A retrospective study was done on clinical data of 27 patients who suffered from hyperextension cervical spine injury combined with intervertebral disk injury to analyze their age distribution, clinical symptomes, X-ray and MRi manifesta-tions and perioperative intervertebral disk injury. All patients were treated with discectomy, strut bone grafting within vertebral bodies and internal fixation with titanium plate. The clinical outcomes were evalu-ated by using Frankel scale and ASIA motor score (AMS). Results Both MRI and X-ray detected following abnormal pathological changes in all patients: rupture of anterior longitudinal ligament, horizon-tal tear of disk, intervertebral disk hernia, compression and edema of spinal cord. The follow-up lasted for 9-32 months (average 17.5 months), which showed that all patients got improvement for 1-3 scales except that one patient with Frankel A had no improvement in neurological function. Compared with AMS on admission, both AMS at two months after surgery and at final follow-up was increased significantly, with recovery rate of AMS for 44.9% and 68.1%, respectively. There found no hardware related compli-cations such as implant loosening, defluxion or breakage. Bone fusion was found in all fixation segments. Conclusions MRI and X-ray are important examination means for hyperextension cervical spine injury combined with intervertebral disk injury. On a specified diagnosis, anterior surgical treatment should be done early and can get satisfactory recovery of spinal cord function.