无骨折脱位颈脊髓中央损伤综合征的手术疗效及其影响因素

Surgical outcomes and risk factors in traumatic central cord syndrome without fracture and dislocation

中文关键词:  颈脊髓中央损伤综合征  椎管狭窄  颈椎手术

英文关键词:Traumatic central cord syndrome  Cervical stenosis  Cervical surgery

中文摘要:

  【摘要】 目的：评估无骨折脱位颈脊髓中央损伤综合征（traumatic central cord syndrome，TCCS）的手术疗效，探讨其影响因素。方法：2007年1月~2014年1月我院收治无骨折脱位的颈椎TCCS患者66例，评估损伤后24h内、术前、术后5d、末次随访时的ASIA评分和JOA评分，测量椎管最大狭窄程度（maximum canal compromise，MCC）及脊髓最大受压程度（maximum spinal cord compression，MSCC）。了解年龄、性别、手术方式、椎管狭窄程度、椎管狭窄节段数及术前ASIA评分与手术前后ASIA评分及JOA评分改善率之间的相关性。按受伤至手术治疗时间分为A（<1周）、B（1~3周）、C（>3周）3组，在不同时间点评估3组患者的脊髓功能情况。结果：66例患者术后5d及末次随访时的JOA评分与ASIA评分均较术前明显增加（P<0.05）；MCC平均为（52.64±10.89）%，MSCC平均为（26.71±13.27）%；MSCC与末次随访时的JOA评分改善率及ASIA评分呈显著性负相关（P<0.05）；患者年龄与JOA评分改善率呈负相关（P<0.05）；术前ASIA评分与末次随访ASIA评分呈正相关（P<0.05）；性别、MCC、椎管狭窄节段数、手术入路与JOA评分改善率及末次随访ASIA评分的无显著相关性（P>0.05）。3组伤后不同时间手术患者之间年龄、性别、手术方式、术前ASIA评分均无统计学差异，末次随访时A组患者JOA评分及ASIA评分明显高于B、C组（P<0.05）；A、B、C组患者的JOA评分改善率平均为（78.4±6.7）%、（71.3±7.8）%、（63.2±9.1）%，三组间具有显著性差异（P<0.05）。结论：采用手术治疗无骨折脱位的颈椎TCCS安全有效，术前ASIA评分、脊髓受压程度、患者年龄影响TCCS预后；尽早（1周内）行减压手术可能更有利于颈脊髓功能恢复。

英文摘要:

  【Abstract】 Objectives: To evaluate the surgical outcome on the traumatic central cord syndrome(TCCS) without fracture and dislocation, and to discuss the risk factors for TCCS prognosis. Methods: 66 TCCS patients were received and reviewed from January 2007 to January 2014 in our hospital, and the ASIA score and JOA score at the time of 24 hours after injury, the day before surgery, 5 days after surgery and the final follow-up were recorded. Maximum canal compromise(MCC) and maximum spinal cord compression(MSCC) were used to measure the compression of the cannel and spinal cord due to stenosis. The relationships between prognosis(improvement ratio of JOA and ASIA score at final follow-up) and related risk factors(age, sex, operation way, the degree of stenosis, stenosis segment number and preoperative ASIA score) were evaluated respectively. All patients were divided into three groups according to the time between injury and surgery including less than 1 week(group A), 1 to 3 weeks(group B) and over 3 weeks(group C) to evaluate the neural function at these time points. Results: The ASIA score and JOA score at 5 days after surgery and final follow-up significantly increased compared with those at preoperation(P<0.05). The average score for MSCC and MCC was (26.71±13.27)% and (52.64±10.89)% respectively. The improvement ratio of JOA and MCCS showed a significantly negative correlation(P<0.05). Age was negtively related with the improvement ratio of JOA(P<0.05). Preoperative ASIA score was positively correlated with the final follow-up ASIA score(P<0.05). While gender, MCC, the number of stenosis segment and the surgical approach had no statistical correlation with the improvement ratio of JOA and the final follow-up ASIA score(P>0.05). Age, sex, operation way, preoperative ASIA score had no statistical difference among three groups at different time points. Group A′s JOA score and ASIA score were significantly higher than those of group B and C at final follow-up, the difference was statistically significant(P<0.05). The improvement ratio of JOA of group A, B, C groups at final follow-up was (78.4±6.7)%, (71.3±7.8)%, (63.2±9.1)% respectively(P<0.05). Conclusions: Operation is safe and effective for TCCS. Surgery within one week is beneficial for neurologi-cally functional recovery. Preoperative ASIA scoring, degree of stenosis caused by spinal cord compression and age may affect the prognosis of TCCS.