CAJ | 학술논문

目的：探讨高压氧治疗儿童先天性脊柱侧弯( congenital scoliosis，CS)矫形术并脊髓损伤( spinal cord injury，SCI)的效果。方法回顾性分析2010年10月—2014年2月在海军总医院住院的11例CS矫形术并SCI患儿的年龄、性别、术前是否存在SCI、术后开始高压氧( hyperbaric oxygen，HBO)治疗的时间、HBO治疗的次数、HBO治疗前后的美国脊髓损伤协会( American Spinal Injury Association，ASIA)评级和预后转归情况。结果11例均接受了手术治疗。4例术前存在SCI的患儿在术后6~27 d开始HBO治疗，平均15?5 d；HBO治疗次数为20~30次，平均23?7次；HBO治疗结束时，患儿运动功能恢复较差，按ASIA评级标准，2例提高1级，另2例无明显恢复。7例术前脊髓功能正常的患儿HBO治疗的时间在术后3~7 d开始，平均5?3 d；HBO治疗次数为7~34次，平均21?5次；HBO治疗结束时，患儿运动功能恢复良好，ASIA评级提高1~3级。随访平均20?6个月，最长42个月，11例大小便均恢复正常；4例术前存在SCI者生存情况堪忧；术前脊髓功能正常患儿中，6例恢复上学及上幼儿园，1例失访。结论 CS矫形手术应在发生严重畸形、出现脊髓功能损害之前早期进行；对于手术造成的SCI，早期联合HBO治疗可能是有效的手段。
목적：탐토고압양치료인동선천성척주측만( congenital scoliosis，CS)교형술병척수손상( spinal cord injury，SCI)적효과。방법회고성분석2010년10월—2014년2월재해군총의원주원적11례CS교형술병SCI환인적년령、성별、술전시부존재SCI、술후개시고압양( hyperbaric oxygen，HBO)치료적시간、HBO치료적차수、HBO치료전후적미국척수손상협회( American Spinal Injury Association，ASIA)평급화예후전귀정황。결과11례균접수료수술치료。4례술전존재SCI적환인재술후6~27 d개시HBO치료，평균15?5 d；HBO치료차수위20~30차，평균23?7차；HBO치료결속시，환인운동공능회복교차，안ASIA평급표준，2례제고1급，령2례무명현회복。7례술전척수공능정상적환인HBO치료적시간재술후3~7 d개시，평균5?3 d；HBO치료차수위7~34차，평균21?5차；HBO치료결속시，환인운동공능회복량호，ASIA평급제고1~3급。수방평균20?6개월，최장42개월，11례대소편균회복정상；4례술전존재SCI자생존정황감우；술전척수공능정상환인중，6례회복상학급상유인완，1례실방。결론 CS교형수술응재발생엄중기형、출현척수공능손해지전조기진행；대우수술조성적SCI，조기연합HBO치료가능시유효적수단。
Objective To discuss the effect of hyperbaric oxygen (HBO) in treatment of children on spinal cord injury ( SCI ) complicated with corrective surgery for congenital scoliosis ( CS) . Methods Eleven cases of SCI complicated with surgery for CS treated in Navy General Hos￣pital from November 2010 to February 2014 were included in this study. The age,gender,compan￣ying with SCI or not before surgery,the beginning time of HBO treatment,times of HBO treatment,ASIA scores before/after HBO treatment, and prognosis were analyzed retrospectively. Results Surgical treatments were performed in all cases. The four cases with SCI before surgery separately be￣gan HBO treatment at the day from the 6th to 27th day after corrective surgery, for average 15?5 days. Times of HBO treatment were 20—30,for average 23?7 times. When HBO treatment finished,the motor function recovered a little,neurologic status of two cases improved by one grade in Ameri￣can Spinal Injury Association(ASIA) grade, and the other two had no recovery. The seven cases without SCI before surgery separately began HBO treatment at the day from the 3rd to 7th after sur￣gery,for average 5?3 days. The treatment were 7—34 times, for average 21?5 times. When HBO treatment finished,all of them have a fairly good motor function,neurologic status improved by 1—3 ASIA grades. The mean follow￣up time was 20?6 months,the longest was 42 months.All cases have normal micturition and defecation function. The four cases with SCI before surgery live in a poor con￣dition. Six of the cases without SCI before surgery go to school/kindergarten, and one case lost to follow￣up. Conclusion The surgical treatment for CS patients should be performed before severe <br> deformity and SCI exist. Combination of early HBO treatment for SCI complicated with CS corrective surgery is possibly effective.