【摘要】 目的比较Ⅰ期手术与分期手术治疗颈椎骨折合并颈髓损伤的疗效差异。方法 2010年6月至2014年10月收治颈椎骨折合并颈髓损伤26例,其中16例采用Ⅰ期前后联合入路手术,10例采用分期手术(Ⅰ期后路减压+内固定手术、Ⅱ期前路椎间盘摘除+椎体固定术),以Frankel分级和日本骨科协会(JOA)评分评估脊髓功能,并计算改善率=(术后JOA评分-术前JOA评分)/(17-术前JOA评分)×100%。结果两组手术前后Frankel分级均无统计学差异(P>0.05)。两组术前JOA评分无统计学差异(P>0.05),两组术后2 d、3个月、6个月JOA评分较术前均明显增高(P<0.05),Ⅰ期手术组增高更明显(P<0.05);术后3、6个月,Ⅰ期手术组改善率均明显高于分期手术组(P<0.05)。结论Ⅰ期前后联合入路手术治疗颈椎骨折合并颈髓损伤,能及时、彻底地解除对脊髓压迫,恢复颈椎稳定性,缩短疗程,近期、远期疗效明显,是安全有效的手术方式。更多还原

【Abstract】 Objective To compare clinical effects of one-stage microneurosurgery through anterio-posterior approach on cervical spine fracture and cervical spinal cord injury(SCI) with those of two-stage operations,of which,stage Ⅰ operation included posterior decompression and internal fixation and stage Ⅱ did intervertebral disk removal and vertebral body fixation.Methods The clinical data of 26 patients with cervical spine fracture and cervical spinal cord injury,of whom,16(group A) were treated by the above-mentioned one-stage microsurgery,and 10(group B) were treated by the above-mentioned two-stage operations,were analyzed retrospectively.The spinal cord functions were assessed by Japanese Orthopedics Association(JOA) scores before and after the surgery.Results There was no significant difference in the preoperative JOA scores between groups A and B.JOA scores and spinal cord function improvement rates were(9.94±2.20) points and 0.384±0.005,(11.94+2.60) points and 0.562+0.011,and(12.88±2.25) points and 0.645±0.011 in group A,and(8.6±1.82) points and 0.259±0.00091,(9.6±1.38) points and 0.346±0.0015,and(10.6±2.71) points and 0.438±0.009 in group B 2days,3 and 6 months after the surgery,respectively.JOA scores and spinal cord function improvement rates were significantly higher in group A than those in group B(P<0.05).Conclusions One-stage microneurosurgery through anterio-posterior approach is a good method to treat cervical spine fracture and cervical spinal cord injury because it can completely and immediately relieve spinal cord compression,restore the stability in the cervical spine and shorten the course of treatment and has better short-term and long-term urative effects.更多还原