摘要
目的回顾性分析手术治疗外伤性颈髓中央综合征的效果，探讨合理评估疗效的方法。方法2001年3月至2005年5月，手术治疗外伤性颈髓中央综合征32例，年龄22-65岁，平均48岁。合并颈椎间盘突出5例，颈椎骨折10例，颈椎明显退变20例。根据颈髓压迫来源，行前路减压、固定及融合术21例，前后路联合减压术8例，单纯后路减压术3例。比较手术前后美国脊髓损伤委员会（American Spinal Injury Association，ASIA）运动功能评分（ASIA motor score，AMS）和恢复率，评估SF-36各项指标及患者满意度。结果32例术后随访11-53个月，平均33个月。1例因内固定物松动于术后4个月将其取出。与入院时相比，术后6个月和末次随访时AMS明显提高，运动功能恢复率分别为53．7％和70.3％。患者年龄、伤后手术时间及伤前是否存在明显颈椎退变对最后的AMS无明显影响；颈椎明显退变组AMS的恢复主要在术后6个月内，而颈椎无明显退变组手术6个月以后仍有AMS的恢复。末次随访时，伤后踝阵挛阳性组的AMS和恢复率高于踝阵挛阴性组。本组术后平均AMS明显提高，但SF-36各项指标及患者自评疗效的满意率并不高，约1／3患者对总体疗效不满意，其中手功能障碍及下肢肌肉痉挛为主要原因。结论手术治疗伴颈髓受压或颈椎不稳的颈髓中央综合征可明显提高AMS，但AMS不能全面反映患者整体功能，结合SF-36等标准可更全面地评估手术远期疗效。
Objective To retrospectively analyze the results of surgical treatment for traumatic central cord syndrome （TCCS）, and explore a more suitable measurement of the patients＇ functional status. Methods A review was performed for surgically treated 32 patients with TCCS from March 2001 to May 2005. Radiographic evaluation revealed acute disc herniation in 5 patients, cervical spine fracture in 10, and significant spondylosis in 20. Surgical indications mainly include significant compression of the Spinal cord or instability of the cervical spine. Surgeries were performed via an anterior approach in 21 patients, via a posterior approach in 3, and via combination of anterior and posterior approaches in 8. Pre- and postoperative ASIA motor score （AMS） and recovery rate were analyzed, postoperative SF-36 scores were collected. Results All these surgeries were performed successfully without any further neurological deterioration except for one patient with misplacement of screw fixation into disc space, the loosened internal fixator was removed 4 months postoperatively. All of the 32 patients were followed up for 11 to 53 months （33 months on average）. Compared with the initial AMS in admission, both the AMS at 6 months after surgery and final follow-up increased significantly. Recovery rates of AMS at 6 months after surgery and final follow-up were 53,7% and 70.3% respectively. Regarding with the final AMS, no significant difference was found between patients under or over 50 years, operated early （≤ 1 week） or late （〉1 week）, with or without significant spondylosis. Patients with positive ankle clonus were prone to obtain higher AMS and recovery rate at final follow-up. Despite a relatively dramatic improvement in motor score, lower scores were obtained using SF-36 questionnaire, and almost 1/3 of patients expressed dissatisfaction with their final symptoms for the main rea- sons of poor hand function and leg spasticity. Conclusion Surgical treatment for TCCS with significant spinal cord compression and（or） cervical instability may increase the AMS, however, AMS alone does not adequately describe functional status. AMS combined with other measurements, such as SF-36, maybe more reliable and valid to evaluate patient＇s quality of life at long-term follow-up.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2007年第8期566-571,共6页
Chinese Journal of Orthopaedics
关键词
脊髓损伤
颈椎
外科手术
治疗结果
Spinal cord injuries
Cervical vertebrae
Surgical procedures, operative
Treatment outcome
