CAJ | 학술논문

目的分析氟骨病胸椎管狭窄症(FTCS)术后脊髓损伤(PSCI)的原因,总结诊断和治疗的方法.方法回顾2006至2009年全椎板减压术治疗的FTCS患者192例,术后出现神经症状恶化16例,1例为术中脊髓损伤排除在外,余15例患者纳入本次研究.确诊时间术后1～14d,通过MRI确定损伤原因为血肿形成(A组6例)和脑脊液漏压迫(B组9例),一经确诊立刻穿刺抽液减压,及时二次手术探查伤口,脊髓减压.结果 15例患者神经功能均获得恢复,JOA评分由二次手术前的(3.0±1.1)分增长到二次手术后12个月时的(7.7±1.4)分(P＜0.05).对PSCI确诊时间和二次手术前后JOA评分改善量建立直线方程y=4.7539-0.1875X(F=14.0107,P=0.0025),存在线性负相关,早期治疗的病例恢复效果明显优于延迟治疗的病例.结论血肿压迫和脑脊液漏是FTCS患者PSCI的主要原因,术中严格止血、硬膜外覆盖物的使用,以及术后合理的负压引流都是有效的预防方法.
목적 분석불골병흉추관협착증(FTCS)술후척수손상(PSCI)적원인,총결진단화치료적방법.방법 회고2006지2009년전추판감압술치료적FTCS환자192례,술후출현신경증상악화16례,1례위술중척수손상배제재외,여15례환자납입본차연구.학진시간술후1～14d,통과MRI학정손상원인위혈종형성(A조6례)화뇌척액루압박(B조9례),일경학진립각천자추액감압,급시이차수술탐사상구,척수감압.결과 15례환자신경공능균획득회복,JOA평분유이차수술전적(3.0±1.1)분증장도이차수술후12개월시적(7.7±1.4)분(P＜0.05).대PSCI학진시간화이차수술전후JOA평분개선량건립직선방정y=4.7539-0.1875X(F=14.0107,P=0.0025),존재선성부상관,조기치료적병례회복효과명현우우연지치료적병례.결론 혈종압박화뇌척액루시FTCS환자PSCI적주요원인,술중엄격지혈、경막외복개물적사용,이급술후합리적부압인류도시유효적예방방법.
Objective To elucidate the etiology of postoperative spinal cord injury (PSCI) for patients undergoing laminectomy for fluorosis thoracic canal stenosis (FTCS) and summarize the methods of diagnosis and treatment.Methods From 2006 to 2009,a total of 192 FTCS cases underwent laminectomy.Among them,16 cases with gradual postoperative neural deterioration were finally diagnosed as PSCI on MRI.One case of intraoperative spinal cord injury was excluded so that only 15 cases were included.Results All cases were treated immediately with incision cite puncture and dehydration.Neural function recovered after secondary operation as JOA score improved from 3.00 ± 1.14 to 7.72 ± 1.41 at 12 months follow-up.Statistical analysis demonstrated a linear correlation between the diagnosis time and the improv,ement of JOA score.Conclusion Hematoma and fluid leakage are the common reasons of PSCI for FTCS patients.Meticulous hemostasis,usageof artificial dura matter and partial negative pressure drainage are valuable preventive measures.