CAJ | 학술논문

目的：分析老年无骨折脱位型颈脊髓损伤的成因及损伤机制，探讨MRI表现、治疗方法选择，并对围手术期管理提出指导。方法回顾2003年3月～2013年10月收治的＞60岁的无骨折脱位型颈脊髓损伤296例，对发生机制、伤后MRI片脊髓信号改变、治疗手段对神经恢复的影响进行分析，对伤后MRI上脊髓T2加权像高信号变化进行分型。结果236例患者MRI T2加权像有信号变化，其中Ⅰ型125例、Ⅱ型79例、Ⅲ型27例、Ⅳ型5例。296例患者中，手术治疗222例，非手术治疗74例。2组神经功能恢复率有明显区别（ P＜0．05）；且伤后早期（＜72 h）手术患者的症状改善率高于稍晚手术患者。伤后颈脊髓内MRI的T2加权像异常信号可以分为4型。结论老年颈脊髓损伤患者有明显神经损伤症状者应尽早手术治疗。患者术前应戒烟、行呼吸功能练习和体位训练，术后应早期离床活动，以促进神经功能恢复及减少并发症发生。
목적：분석노년무골절탈위형경척수손상적성인급손상궤제，탐토MRI표현、치료방법선택，병대위수술기관리제출지도。방법회고2003년3월～2013년10월수치적＞60세적무골절탈위형경척수손상296례，대발생궤제、상후MRI편척수신호개변、치료수단대신경회복적영향진행분석，대상후MRI상척수T2가권상고신호변화진행분형。결과236례환자MRI T2가권상유신호변화，기중Ⅰ형125례、Ⅱ형79례、Ⅲ형27례、Ⅳ형5례。296례환자중，수술치료222례，비수술치료74례。2조신경공능회복솔유명현구별（ P＜0．05）；차상후조기（＜72 h）수술환자적증상개선솔고우초만수술환자。상후경척수내MRI적T2가권상이상신호가이분위4형。결론노년경척수손상환자유명현신경손상증상자응진조수술치료。환자술전응계연、행호흡공능연습화체위훈련，술후응조기리상활동，이촉진신경공능회복급감소병발증발생。
Objective To analyze the cause and the injury mechanism of the elderly cervical spinal cord injury without fracture and dislocation (CSCIWFD), to discuss the MRI characteristics and therapeutic method , and to provide the guidance for the perioperative management .Methods A total of 296 CSCIWFD cases ( more than 60 years old ) treated from March 2003 to October 2013 were involved in this study .The pathogenesis , the spinal cord signal changes on MRI , and the neuro-logical therapeutic outcomes of CSCIWFD were analyzed retrospectively .Results Of all patients, MRI T2WI signals of 236 cases were changed (125 cases of Type Ⅰ、79 cases of Type Ⅱ, 27 cases of Type Ⅲ, 5 cases of Type Ⅳ.Among 296 case, there were 222 cases in operation group and 74 cases in non-operation group .The neurological function recovery rate has sig-nificant difference between 2 groups (P<0.05), and the symptomatic improvement rate of early stage surgical treatment (<72 h) was higher than late stage surgical treatment .Conclusion The elderly CSCIWFD patients with significant neurological symptoms should be treated by surgery as early as possible .They should quit smoke , carry out both breathing exercises and postural training before operation .In addition , postoperative early out of bed rehabilitative exercises contributes to not only the neurological function recovery but also the reduction of complications .