【作者】 张强； 马华松； 鲍磊； 陈晓明； 陈志明； 周建伟； 汪东； 马晓明； 邵燕翔； 肖曦； 邹德威；

【Author】 ZHANG Qiang,MA Hua-song,ZOU De-wei,et al.Orthopedic Depart- ment,306 Hospital of PLA,Beijing,100101.

【机构】 解放军第306医院骨科全军脊柱外科中心；

【摘要】 [目的]探讨早期减压和Window钢板内固定治疗外伤性颈椎骨折脱位脊髓损伤的作用。[方法]采用Window钢板对38例颈脊髓损伤患者行颈前路减压植骨内固定。本组在伤后24h内手术者12例,伤后24～72h手术者20例,伤后72h～1mon手术者6例。患者神经功能根据美国脊髓损伤协会(AmericanSpinal Injury Association,ASIA)损伤系统分级法,其中7例患者为完全性脊髓损伤,31例为不完全性损伤。患者平均年龄是35.5岁(16～69岁),平均随访时间28个月(12～60个月)。[结果]手术后12个月随访发现38例患者中36例颈前路减压植骨获骨性愈合,植骨融合率是94.7%。术后椎间高度及生理弯曲维持满意,无一例发生内固定器械并发症。24h减压组Frankel分级平均改善1.56级,24～72h减压组Frankel分级平均改善0.82级,72h～1mon延迟减压组Frankel分级平均改善0.64级;24h减压组与24～72h减压组和72h～1mon延迟减压组比较,有显著差异性(P<0.05)。[结论]采用Window钢板对颈椎骨折脱位脊髓损伤患者行颈椎间融合,能充分保证固定节段的稳定性,植骨愈合率高,有效地维护了伤椎椎间高度和生理曲度。研究结果表明早期手术减压将明显改善神经功能,延期减压同样也能获得较好的神经功能结果。我们建议对于颈脊髓不完全损伤神经症状进行性加重的患者应急诊手术减压治疗。更多还原

【Abstract】 [Objective]To study the effective on early operative decompression and application of window cervical dynamic fixator in the treatment of traumatic cervical spine fracture and dislocation with spinal cord injury.[Methods]Thirty-eight cases cervical spinal cord injuries were treated with anterior decompression, intervertebral fusion with window cervical dynamic fixator.The early operative decompression (<24hours) of the cervical spinal cord was done in 12 patients.The middle early operative decompression (range of 24-72 hours) was done in 20 patients.The delayed operative decompression(range of 72 hours- 1 month) was done in 6 patients.The neurologic clinical status of patients was assessed according to the ASIA(American Spinal Injury Association) impairment scale.In neurological terms 7 patients were completely and 31 incompletely impaired.The mean patient age was 35.5 years(range of 16～69) and the average follow-up time was 28 months(range of 12～60).[Results]Among 38 cases,thirty-six cases were complete fusion of bone graft were observed in 12 months after operation.The fusion rate was 94.7%.The intervertebral height and physiology curves were maintained satisfy,with no obvious complication of hardware fixation.Three patients has not improved and still had Franke1A degree but 35 remaining patients have improved neurologically at follow-up.The early operative decompression Group recovered by 1.56 degree, middle early decompression group recovered by 0.82 degree and delayed decompression group recovered by 0.64 degree on the Franke1 scale respectively.A significant difference in the Franke1scale was observed between the 24 hours decompression group compare to other two groups(P<0.05) indicating a more favorable neurological outcome when earlier decompression is undertaken.[Conclusion]This kind of window cervical dynamic fixator can ensure the stability of the fixation segments and promote bone fusion, maintenance intervertebral height,physiology cures.Analysis of the findings in this study suggests that early decompression improves neurological function.Prolongation of the time to decompression may also result in better neurological outcomes.We recommend urgent decompression of patients with incomplete tetraplegia or in patients with spinal cord injury experiencing neurological deterioration.更多还原