摘要
目的 探讨硬脊膜或脊髓切开减压治疗脊髓损伤后广泛水肿伴或不伴髓内血肿的必要性及可行性.方法 2009年1月至2014年9月采用硬脊膜或脊髓切开减压治疗脊髓损伤后广泛水肿伴或不伴髓内血肿的患者21例,男13例,女8例;年龄13～69岁,平均39.1岁.16例有脊柱骨折脱位,9例有单侧或双侧关节突绞锁,12例有椎间盘损伤.水肿部位：颈髓18例,胸腰髓3例;水肿范围为2～4个节段者17例,超过4个节段者4例.血肿部位：颈髓4例,胸腰髓1例;血肿范围为1～2个节段.结果 术后均未发生伤口感染、脊髓损伤加重、椎动脉损伤及椎间盘突出加重.术后2周MRI示脊髓广泛水肿信号消失,脑脊液信号连续性恢复.术前美国脊髓损伤协会（America Spinal Injury Association,ASIA）脊髓损伤A级者6例,术后分级未见好转,感觉平面下降2～4个节段,部分上肢肌力恢复1～2级;B级10例,7例提高为C级、2例提高为D级、1例提高为E级;C级5例,4例提高为D级、1例提高为E级.5例髓内血肿患者ASIA分级A级2例,感觉平面下降2个节段,部分上肢肌力恢复1级;B级2例,1例提高为C级、1例提高为D级;C级1例,提高为D级.结论 对脊髓损伤后脊髓广泛水肿伴或不伴髓内血肿者,硬脊膜切开和适当的脊髓切开能够缓解动静脉受压,减轻继发性损伤,为抢救患者创造条件,有助于脊髓神经功能的恢复.
Objective To evaluate the necessity and feasibility of durotomy or myelotomy for the spinal cord extensive swelling with/without intramedullary hemorrhage.Methods Data of 21 cases with spinal cord extensive swelling with/without intramedullary hemorrhage who underwent durotomy or myelotomy from January 2009 to September 2014 were retrospectively analyzed.There were 13 males and 8 females,with an average age of 39.1 （range,13-69） years old.16 cases had the situation of spinal fracture or dislocation,9 cases had locked facet,and 12 cases had disc injury.The swelling locations of 18 cases were at cervical cord,and 3 at thoracolumbar cord.The swelling area of 17 cases were at 2-4 segments,and 4 cases over 4 segments.Results No wound infection,aggravated disk hernia,aggravated spinal cord injury,vertebral artery injury or aggravated disc injury happened in any cases.The MRI of two weeks after operation showed that the high signal of swelling disappeared in T2WI.According to the American Spinal Cord Injury Association （ASIA） Impairment Scale,6 grade A cases were still grade A,but the feeling and movement improved obviously.7 grade B cases improved to grade C,2 grade B cases improved to grade D,and 1 grade B case improved to grade E.4 grade C cases improved to grade D,and 1 grade C case improved to grade E.For the patients with intramedullary hemorrhage,2 grade A cases were still grade A with improvement in feeling and movement,1 grade B improved to grade C,1 grade B improved to grade D,and 1 grade C improved to grade D.Conclusion For the patients with spinal cord extensive swelling with/without intramedullary hemorrhage,the durotomy or myelotomy is safe and efficacious which could relief the blockade of spinal epidural veins,arteriole of cord.It may also reduce the secondary injury,create conditions for improving breathing,circulating and rescuing the life,and it could be helpful for the recovery of spinal cord neurological function.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2015年第7期707-713,共7页
Chinese Journal of Orthopaedics
基金
中国国家国际科技合作项目（2013DFG32690）
国家自然科学基金（81371939、81171684）
关键词
脊髓损伤
血肿
硬膜下
脊髓
减压术
外科
Spinal cord injuries
Hematoma,subdural,spinal
Decompression,surgical
