【摘要】 目的总结脊髓损伤后早期显微镜下清创与修复的手术经验。方法脊柱骨折或脱位后路手术经伤椎弓根撬拨复位、植骨完成后,损伤区域在手术显微镜下行挫伤坏死碎片、凝血块清除,修复损伤的微小血管和神经,早期恢复血运。结果94例患者获得随访。术后X线摄片及CT检查示椎体复位率95%,且椎管有效容量复原。按Frankel分级标准,术前A级7例术后无变化;87例患者获得1～2级以上的改善,有效率93%,其中获2级以上恢复患者57例,占有效率的66%;伤后至手术时间平均7.6h;镜下平均手术时间46min;术后平均开始出现功能恢复时间为36h。结论脊髓损伤早期显微镜下清创和修复有利于减少原发性、继发性损伤反应,降低神经组织水肿,缩短神经功能恢复时间。更多还原

【Abstract】 Objective To evaluate the microsurgical experience of debridement and repairing in operation for spinal cord injury. Methods After reduction and internal screw fixation for patients suffering from vertebrae fracture or dislocation, the necrosis, tissue splinters and blood clots at the injury site were cleared, and small vessels and nerves were repaired with microsurgery. The blood circulation at the injury section was restored early. Results 94 cases were followed up. X ray and CT showed that the reduction rate of injured vertebra was 95% . According to the standard of FRANKEL,7 cases of grade A were still grade A after the spinal cord operation. 87 cases had one or two grades of improvement.The rate of efficiency was 93% . 57 cases had two grades or more of restoration. The average time for the microsurgical operation was 47 min. The average internal between injury and operation was 7.6h. The average time of the beginning of restoration was 36 h after operation. Conclusion The microsurgical treatment of cleaning and repairing can reduce the primary and secondary injury response, the edema of nerve tissue, and the time for nerve and functional rehabilitation.更多还原