手术与保守治疗急性创伤性下颈段脊髓损伤的疗效比较

doi:10.3760/cma.j.cn101202-20211026-00302

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摘要目的对比急性创伤性下颈段脊髓损伤患者手术治疗与保守治疗的临床疗效。方法回顾性队列研究。纳入2014年1月—2020年4月云浮市人民医院骨外科急性创伤性下颈段脊髓损伤患者60例,其中男48例、女12例,年龄35~77岁。根据治疗方式不同将患者分为2组,接受手术治疗的30例为手术组、保守治疗30例为保守组。保守组30例给予颈托固定、心电监护、甘露醇脱水减压、激素冲击疗法、保护胃黏膜、加强营养指导等方法治疗,手术组根据患者脊髓损伤具体情况选择前入路、后入路或前后联合入路手术治疗。2组患者治疗前后依据美国脊柱损伤协会（ASIA）脊柱神经功能评级标准评估神经功能,采用日本骨科协会（JOA）评分标准评定脊柱功能,采用JOA评分改善率评估患者临床疗效。观察2组患者治疗前、治疗后1年神经功能、脊柱功能和临床疗效,并进行组内、组间比较。结果 2组患者性别、年龄、入院时脊柱神经功能分级和JOA脊柱功能各项评分等基线资料比较差异均无统计学意义（P值均>0.05）。保守组均完成静脉用药3周、颈托固定2个月的保守治疗,手术组患者均顺利完成椎管减压、植骨融合内固定手术。患者出院后均获随访12~16个月。治疗后1年,2组患者 ASIA脊柱神经功能评级均较治疗前有所改善,JOA脊柱功能各项评分均高于治疗前;手术组患者脊柱神经功能评级优于保守组,JOA脊柱功能各项评分均高于保守组：差异均有统计学意义（P值均<0.01）。手术组患者治疗后1年临床疗效的总优良率为90.0%（27/30）,高于保守组的46.7%（14/30）,差异有统计学意义（Z=3.81,P<0.001）。结论急性创伤性下颈段脊髓损伤患者的手术治疗在改善神经功能、脊柱功能方面优于保守治疗,临床疗效显著,可优先考虑手术治疗。

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	林伟鹏
	邹仲兵
	王华国
	黄永锋
	欧荣通
	叶劲
	白波

关键词 ：脊髓损伤, 创伤性, 下颈段, 手术治疗, 保守治疗, 神经功能, 脊柱功能

Key words： Spinal cord injuries Acute traumatic Lower cervical Surgery treatment Conservative treatment Nerve function Spine function

收稿日期: 2021-10-26

基金资助:广东省医学科学技术研究基金（B2015119）; 云浮市医药卫生类科技计划（WS201904）

通讯作者: 叶劲,Email：Yeking2006@163.com

引用本文:

林伟鹏, 邹仲兵, 王华国, 黄永锋, 欧荣通, 叶劲, 白波. 手术与保守治疗急性创伤性下颈段脊髓损伤的疗效比较[J]. 中华解剖与临床杂志, 2022, 27(12): 865-870.
Lin Weipeng, Zou Zhongbin, Wang Huaguo, Huang Yongfeng, Ou Rongtong, Ye Jin, Bai Bo. Analysis of the curative effect of acute traumatic lower cervical spinal cord injury. Chinese Journal of Anatomy and Clinics, 2022, 27(12): 865-870.

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