CAJ | 학술논문

目的探讨两端跳跃式过伸性颈椎间盘韧带复合体(DLC)裂伤合并脊髓损伤的诊治特点.方法对2008年1月至2012年12月17例两端跳跃式过伸性颈DLC裂伤合并脊髓损伤患者资料进行回顾性分析,男15例,女2例;年龄21 ～ 57岁,平均36.3岁.根据神经平面结合颈椎MRI T2WI髓内高信号征确定脊髓损伤节段,根据术前MRI及X线片颈椎稳定性判断DLC裂伤节段.所有患者均有颈椎两端跳跃式前纵韧带和椎间盘裂伤,均采用手术治疗.术后采用美国脊髓损伤协会评分标准对神经功能进行评定,比较术前、术后3、6、12个月美国脊髓损伤协会的运动功能评分(AMS)及感觉功能评分(ASS).观察有无内固定物失败及植骨愈合情况. 结果所有患者术后随访12 ～42个月,平均28个月.所有患者术后各时相点AMS、ASS与术前比较差异均有统计学意义(P＜0.05),而且随着随访时间增加,AMS、ASS明显恢复,术后两两时间点比较差异均有统计学意义(P＜0.05).椎间植骨愈合良好,无内固定物松动、脱出、断裂等失败征像. 结论两端跳跃式过伸性DLC裂伤合并脊髓损伤患者容易漏诊.手术方式应包括主要颈髓损伤受压DLC裂伤节段脊髓减压稳定,同时兼顾另一端DLC裂伤节段稳定性重建.
목적 탐토량단도약식과신성경추간반인대복합체(DLC)렬상합병척수손상적진치특점.방법 대2008년1월지2012년12월17례량단도약식과신성경DLC렬상합병척수손상환자자료진행회고성분석,남15례,녀2례;년령21 ～ 57세,평균36.3세.근거신경평면결합경추MRI T2WI수내고신호정학정척수손상절단,근거술전MRI급X선편경추은정성판단DLC렬상절단.소유환자균유경추량단도약식전종인대화추간반렬상,균채용수술치료.술후채용미국척수손상협회평분표준대신경공능진행평정,비교술전、술후3、6、12개월미국척수손상협회적운동공능평분(AMS)급감각공능평분(ASS).관찰유무내고정물실패급식골유합정황. 결과 소유환자술후수방12 ～42개월,평균28개월.소유환자술후각시상점AMS、ASS여술전비교차이균유통계학의의(P＜0.05),이차수착수방시간증가,AMS、ASS명현회복,술후량량시간점비교차이균유통계학의의(P＜0.05).추간식골유합량호,무내고정물송동、탈출、단렬등실패정상. 결론 량단도약식과신성DLC렬상합병척수손상환자용역루진.수술방식응포괄주요경수손상수압DLC렬상절단척수감압은정,동시겸고령일단DLC렬상절단은정성중건.
Objective To explore the diagnosis and treatment of skipping amphi-laceration of disco-ligamentous complex (DLC) combined with hyperextension injury to the cervical spinal cord.Methods From January 2008 to December 2012,17 cases of skipping amphi-laceration of DLC combined with hyperextension injury to the cervical spinal cord were surgically treated at our department.They were 15 men and 2 women,21 to 57 years of age (average,36.3 years).Cervical spine MRI and dynamic flexion-extension lateral radiographs were performed in all patients preoperatively.Injured spinal cord segments were determined according to the plane of spinal cord injury and high signal changes in spinal cord on MRI.Segments of DLC laceration were evaluated according to cervical spine MRI and subaxial cervical stability on radiographs preoperatively.The neurological functions were graded according to the American Spinal Injury Association (ASIA) scale (version 2000) at preoperation,3,6 and 12 months postoperatively.The ASIA mnotor scores (AMS) and sensory scores (ASS) were analyzed statistically.Instrument failure and bony fusion were observed by follow-up radiographs.Results The 17 cases were followed up for an average of 28 months (from 12 to 42 months).The AMS and ASS at all postoperative time points were significantly better than those at preoperation in all patients (P ＜ 0.05).Moreover,the AMS and ASS significantly improved as the follow-up time increased,with a significant difference between postoperative time points (P ＜ 0.05).There was no failure of instrumentation and bony fusion was observed in all cases of bone grafting.Conclusions The skipping amphi-laceration of DLC combined with hyperextension injury to the cervical spinal cord is likely to be missed in diagnosis.The surgical procedures include decompression of the main spinal cord segment with hyperextension injury and DLC laceration and stability reconstruction of the lacerated DLC segment at the other end.