中国骨与关节外科
中國骨與關節外科
중국골여관절외과
CHINESE BONE AND JOINT SURGERY
2013年
5期
392-396,402
,共6页
李硕%周云%荆珏华%钱军%田大胜%陈磊%许新忠%吕浩%游木荣%张积森%姚运峰%李军%汤健%江曙
李碩%週雲%荊玨華%錢軍%田大勝%陳磊%許新忠%呂浩%遊木榮%張積森%姚運峰%李軍%湯健%江曙
리석%주운%형각화%전군%전대성%진뢰%허신충%려호%유목영%장적삼%요운봉%리군%탕건%강서
颈椎%中央脊髓综合征%手术治疗%预后
頸椎%中央脊髓綜閤徵%手術治療%預後
경추%중앙척수종합정%수술치료%예후
cervical vertebrae%traumatic central cord syndrome%surgical treatment%prognosis
背景：中央脊髓综合征是常见的不完全性颈脊髓损伤，目前关于其手术与非手术处理的利与弊仍是脊柱外科争论的焦点。目的：探讨中央脊髓综合征的手术治疗效果及预后。<br> 方法：回顾性分析2009年1月至2012年6月采用手术治疗的34例中央脊髓综合征患者的临床资料，男24例，女10例；年龄39~76岁，平均53.6岁；前路手术26例，后路手术8例。采用日本骨科协会（JOA）评分标准对患者神经功能进行评定，记录所有患者术前、术后6个月及末次随访的JOA评分，评估手术疗效并分析其预后情况。<br> 结果：34例患者全部获得随访，随访时间为6~23个月，平均（14.5±3.8）个月。术前JOA评分平均为（8.8±1.8）分，术后6个月提高至（13.9±2.1）分，末次随访为（14.6±1.5）分。术后6个月及末次随访时的评分改善率分别为（66.1±21.6）%和（73.6±15.2）%。术后1例发生脑脊液漏，1例发生硬膜外血肿，无一例发生椎动脉损伤、切口感染、内固定物失败等并发症。<br> 结论：手术解除椎管内的压迫是治疗中央脊髓综合征的有效方法。对于诊断明确的中央脊髓综合征，在全身情况允许的条件下，宜早期根据椎管内脊髓损伤的节段、压迫来源及程度等选择相应的手术方案，以改善脊髓内血供，减少脊髓继发性损害，促进神经功能的改善和恢复。
揹景：中央脊髓綜閤徵是常見的不完全性頸脊髓損傷，目前關于其手術與非手術處理的利與弊仍是脊柱外科爭論的焦點。目的：探討中央脊髓綜閤徵的手術治療效果及預後。<br> 方法：迴顧性分析2009年1月至2012年6月採用手術治療的34例中央脊髓綜閤徵患者的臨床資料，男24例，女10例；年齡39~76歲，平均53.6歲；前路手術26例，後路手術8例。採用日本骨科協會（JOA）評分標準對患者神經功能進行評定，記錄所有患者術前、術後6箇月及末次隨訪的JOA評分，評估手術療效併分析其預後情況。<br> 結果：34例患者全部穫得隨訪，隨訪時間為6~23箇月，平均（14.5±3.8）箇月。術前JOA評分平均為（8.8±1.8）分，術後6箇月提高至（13.9±2.1）分，末次隨訪為（14.6±1.5）分。術後6箇月及末次隨訪時的評分改善率分彆為（66.1±21.6）%和（73.6±15.2）%。術後1例髮生腦脊液漏，1例髮生硬膜外血腫，無一例髮生椎動脈損傷、切口感染、內固定物失敗等併髮癥。<br> 結論：手術解除椎管內的壓迫是治療中央脊髓綜閤徵的有效方法。對于診斷明確的中央脊髓綜閤徵，在全身情況允許的條件下，宜早期根據椎管內脊髓損傷的節段、壓迫來源及程度等選擇相應的手術方案，以改善脊髓內血供，減少脊髓繼髮性損害，促進神經功能的改善和恢複。
배경：중앙척수종합정시상견적불완전성경척수손상，목전관우기수술여비수술처리적리여폐잉시척주외과쟁론적초점。목적：탐토중앙척수종합정적수술치료효과급예후。<br> 방법：회고성분석2009년1월지2012년6월채용수술치료적34례중앙척수종합정환자적림상자료，남24례，녀10례；년령39~76세，평균53.6세；전로수술26례，후로수술8례。채용일본골과협회（JOA）평분표준대환자신경공능진행평정，기록소유환자술전、술후6개월급말차수방적JOA평분，평고수술료효병분석기예후정황。<br> 결과：34례환자전부획득수방，수방시간위6~23개월，평균（14.5±3.8）개월。술전JOA평분평균위（8.8±1.8）분，술후6개월제고지（13.9±2.1）분，말차수방위（14.6±1.5）분。술후6개월급말차수방시적평분개선솔분별위（66.1±21.6）%화（73.6±15.2）%。술후1례발생뇌척액루，1례발생경막외혈종，무일례발생추동맥손상、절구감염、내고정물실패등병발증。<br> 결론：수술해제추관내적압박시치료중앙척수종합정적유효방법。대우진단명학적중앙척수종합정，재전신정황윤허적조건하，의조기근거추관내척수손상적절단、압박래원급정도등선택상응적수술방안，이개선척수내혈공，감소척수계발성손해，촉진신경공능적개선화회복。
Background:Traumatic central cord syndrome is a common type of incomplete spinal cord injury, the advantages and disad-vantages of its surgical and non-surgical treatments have always been the bone of contention in the spine surgery field. <br> Objective:To evaluate the effect and prognosis of surgical treatment for the traumatic central cord syndrome. <br> Methods: To retrospectively analyze the clinical data of 34 patients who received surgical treatment for traumatic central cord syndrome from January 2009 to June 2012. Aged from 39-76, these 24 males and 10 females had an average age of 53.6. Twenty-six of them received the surgery from anterior approach, and the rest of them received from the posterior ap-proach. The Japanese Orthopaedic Association (JOA) scoring standard was adopted in assessing the neurological function of the patients. JOA scores were collected before and 6 months after the surgery, and also at the last follow-up. The surgical effect and prognosis were evaluated and analyzed. <br> Results:All the 34 patients were followed up for a period of 6-23 months, the mean follow-up period was 14.5±3.8 months. The mean JOA score rose from 8.8 ± 1.8 before the surgery to 13.9 ± 2.1 six months after the surgery, and was increased to 14.6±1.5 at the last follow-up. The recovery rates at 6 months after the surgery and at the last follow-up were (66.1±21.6)%and (73.6±15.2)%respectively. One patient experienced cerebrospinal fluid leakage after the surgery, another patient experi-enced spinal epidural hematoma, but no serious complications like vertebral artery injury, wound infection, or internal fixa-tion failure happened. <br> Conclusions:Relieving the compression in spinal canal with surgical treatment is an effective way in treating the traumatic cen-tral cord syndrome. For the clearly diagnosed traumatic central cord syndrome, it is recommended that a surgical plan be tailored according to the segment of the injured spinal cord in the spinal canal and the source and the degree of the compression as earlier as possible if the patient's physical condition is allowed. So that the blood supply in the spinal cord can be improved, the second-ary lesion of the spinal cord can be reduced, and the improvement and recovery of the neurological function can be promoted.
