CAJ | 학술논문

目的比较无骨折脱位型颈髓损伤(cervical spinal cord injury without fracture or dislocation,CSCIWFD)非手术治疗和手术治疗的疗效,分析其发生机制及其与预后的关系. 方法回顾性分析1994年8月-2013年3月收治的CSCIWFD患者688例,对不同年龄段患者采用非手术治疗(非手术组,155例)和手术治疗(手术组,533例)后神经功能的恢复结果进行比较,分析不同年龄组患者、不同治疗方法与预后的相关性. 结果随访3 ～ 36个月,平均17.9个月.两组患者神经功能改善程度按日本骨科学会(Japanese Orthopedic Association,JOA)评分:(1)40岁以上各年龄段患者神经功能改善率手术组均优于非手术组(P＜0.05)；(2)39岁以下年轻患者无论非手术或是手术治疗恢复均不理想,两组之间比较差异无统计学意义(P＞0.05). 结论不同年龄CSCIWFD患者损伤机制不同,脊髓损伤程度及预后也不同.对40岁以上CSCIWFD患者手术治疗效果优于非手术治疗.对39岁以下年轻CSCIWFD患者手术和非手术治疗预后均较差.
목적 비교무골절탈위형경수손상(cervical spinal cord injury without fracture or dislocation,CSCIWFD)비수술치료화수술치료적료효,분석기발생궤제급기여예후적관계. 방법 회고성분석1994년8월-2013년3월수치적CSCIWFD환자688례,대불동년령단환자채용비수술치료(비수술조,155례)화수술치료(수술조,533례)후신경공능적회복결과진행비교,분석불동년령조환자、불동치료방법여예후적상관성. 결과 수방3 ～ 36개월,평균17.9개월.량조환자신경공능개선정도안일본골과학회(Japanese Orthopedic Association,JOA)평분:(1)40세이상각년령단환자신경공능개선솔수술조균우우비수술조(P＜0.05)；(2)39세이하년경환자무론비수술혹시수술치료회복균불이상,량조지간비교차이무통계학의의(P＞0.05). 결론 불동년령CSCIWFD환자손상궤제불동,척수손상정도급예후야불동.대40세이상CSCIWFD환자수술치료효과우우비수술치료.대39세이하년경CSCIWFD환자수술화비수술치료예후균교차.
Objective To compare the effect of conservative and operative treatment for cervical spinal cord injury without fracture and dislocation (CSCIWFD)and to detect mechanism of injury as well as its relationship to outcome.Methods A retrospective review was conducted on 688 patients with CSCIWFD treated from August 1994 to March 2013.There were 155 patients managed conservatively (conservation group) and 533 surgically (operation group).Neurological function improvement was compared between two groups to detect the correlation of patents' age and treatment methods with outcome.Results The patients were followed up for mean 17.9 months (range,3-36 months).Neurological function was estimated using Japanese Orthopedic Association (JOA) score:(1) the recovery rate of patients aged over 40 years in operation group was better than that in conservation group (P ＜0.05) ; (2) the recovery rate in patients aged under 39 years was unsatisfactory in both groups,with insignificant difference between the two groups (P ＞ 0.05).Conclusions Different age of patients with CSCIWFD has different injury mechanism,injury severity and outcome.Surgery provides better results than conservative treatment for patients aged over 40 years,but both results are poor for patients aged under 39 vears.