CAJ | 학술논문

目的分析氟骨病颈椎管狭窄症(flurosis cervical canal stenosis,FCCS)术后血肿造成脊髓损伤的原因,总结早期诊断和治疗方法. 方法回顾性分析2006-2009年采用后路单开门椎管成形术(expansive laminoplasty,ELOP)治疗的FCCS患者329例.18例患者术后2周内出现神经症状恶化,其中男11例,女7例；年龄45～73岁,平均56.9岁.确诊时间为术后1-5d,通过复查MRI确定损伤原因均为血肿形成(发生率为5.47％),一经确诊立即局部穿刺减压,俯卧位制动,及时行二次手术探查和脊髓减压. 结果 18例患者神经症状均获得不同程度恢复,日本骨科学会(JOA)评分术前为(7.44±1.25)分,术后12个月为(12.6±2.1)分.对脊髓损伤确诊时间和二次手术前后JOA评分改善量绘制散点图,建立直线相关方程Y=6.240 7-0.777 8X(F=9.89,P＜0.01),两者存在线性负相关,获得早期治疗的患者恢复效果明显优于延迟治疗的患者.结论血肿压迫是FCCS患者术后脊髓损伤的主要原因,术中严格止血、术后交替双侧卧位是有效的预防方法,早期诊断和及时治疗至关重要.
목적 분석불골병경추관협착증(flurosis cervical canal stenosis,FCCS)술후혈종조성척수손상적원인,총결조기진단화치료방법. 방법 회고성분석2006-2009년채용후로단개문추관성형술(expansive laminoplasty,ELOP)치료적FCCS환자329례.18례환자술후2주내출현신경증상악화,기중남11례,녀7례；년령45～73세,평균56.9세.학진시간위술후1-5d,통과복사MRI학정손상원인균위혈종형성(발생솔위5.47％),일경학진립즉국부천자감압,부와위제동,급시행이차수술탐사화척수감압. 결과 18례환자신경증상균획득불동정도회복,일본골과학회(JOA)평분술전위(7.44±1.25)분,술후12개월위(12.6±2.1)분.대척수손상학진시간화이차수술전후JOA평분개선량회제산점도,건립직선상관방정Y=6.240 7-0.777 8X(F=9.89,P＜0.01),량자존재선성부상관,획득조기치료적환자회복효과명현우우연지치료적환자.결론 혈종압박시FCCS환자술후척수손상적주요원인,술중엄격지혈、술후교체쌍측와위시유효적예방방법,조기진단화급시치료지관중요.
Objective To study the causes of hematoma-induced spinal cord injury after surgical treatment of fluorosis cervical canal stenosis (FCCS) so as to conclude the methods for early diagnosis and treatment.Methods A retrospective review was conducted on 329 cases of FCCS undergone expansive laminoplasty (ELOP) between 2006 and 2009.Eighteen out of the 329 cases presented with neural deterioration in postoperative 2 weeks,including l 1 males and 7 females at age of 45-73 years (mean 56.9 years).MRI scan at postoperative 1-5 days confirmed that the injury cause was hematoma formation (incidence of 5.47％).Once the definite diagnosis was made,immediate local puncture decompression,immobilization in the prone position as well as a timely second surgical probe and spinal decompression were performed.Results Nerve symptom of the 18 cases obtained different degree of recovery.Japanese Orthopedic Association (JOA) score promoted from preoperative (7.44 ± 1.25) points to (12.6 ± 2.1)points at 12 months after second operation.Scatter plot between time of definite diagnosis and improvement value in JOA score before and after the second operation was drawn so as to establish linear equation (Y =6.240 7-0.777 8X(F =9.89,P ＜0.01).As a result,the two variables presented a negative linear relationship,which suggested a better outcome after early treatment than delayed treatment.Conclusions Hematoma compression is the main cause of spinal cord injury following operation for FCCS patients.Strict hematosis and alternate lateral clinostatism after operation were effective prevention methods.Besides,early diagnosis and timely treatment are critically important.