SLIC评分在下颈椎损伤术式选择中的应用价值

Role of sub-axial injury classification score in the selection of surgical approach in lower cervical spine trauma

中文关键词:  下颈椎损伤  下颈椎损伤分类评分  手术入路

英文关键词:Lower cervical trauma  Sub-axial injury classification  Approach

中文摘要:

  【摘要】 目的：探讨下颈椎损伤分类（sub-axial injury classification，SLIC）评分在下颈椎损伤术式选择中的应用价值。方法：收集我院2009年1月~2013年9月收治的单节段下颈椎损伤患者126例，其中男86例，女40例，年龄16~72岁（46.4±4.3岁）。高处坠落伤28例，车祸伤62例，跌倒伤21例，高空坠物砸伤15例。损伤部位：C3/4 19例，C4/5 34例，C5/6 52例，C6/7 21例。脊髓损伤程度按照美国脊髓损伤协会（ASIA）标准分级，A级7例，B级48例，C级54例，D级17例。以前柱或前中柱损伤为主的患者45例，以后柱损伤或中、后柱损伤为主的患者13例，三柱均损伤的患者68例。术前进行SLIC评分，其中4分13例，5分24例，6分23例，7分29例，8分17例，9分13例，10分7例。根据患者受伤机制、椎体损伤形态特点、脊髓受压部位及损伤程度等因素综合分析选择手术方案，85例患者采用前路手术治疗，其中7例三柱严重损伤的患者因全身情况不能耐受手术放弃前后联合手术而选择单纯前路手术；12例行后路手术，其中2例关节突绞锁的患者SLIC评分为8分；29例采用前后联合术式，其中1例为强直性脊柱炎患者。按照损伤程度，将SLIC评分4~5分归类为轻度损伤，6~7分为中度损伤，8~10分为重度损伤，分析三种术式患者的SLIC评分情况，总结规律。结果：前路手术患者SLIC评分为5.95±1.31分（4~10分），后路手术患者为6.25±1.29分（4~8分），前后联合入路手术患者为8.76±0.83分（7~10分）。前路手术组轻、中、重度损伤分别为34、44、7例，4~7分者占92%；后路手术组轻、中、重度损伤分别为4、6、2例，4~7分者占83%；前后联合入路手术组中度和重度损伤分别为1、28例，8~10分者占97%。结论：对单节段下颈椎损伤患者，当SLIC评分≥8分时，倾向于选择前后联合术式；SLIC评分在4~7分时，倾向于选择单纯前路或后路手术。

英文摘要:

  【Abstract】 Objectives: To discuss the role of sub-axial injury classification(SLIC) score in the selection of surgical approach in lower cervical spine trauma. Methods: A total of 126 patients, 86 males and 40 females with a mean age of 46.4±4.3 years(ranging from 16 to 72 years) who had lower cervical trauma and had been treated surgically from January 2009 to September 2013, were analyzed retrospectively. 28 patients were injured due to high fall, 62 patients by accident, 21 by falls, 15 were hit by falling objects. The number of injuries in each segment was: C3/4 in 19 cases, C4 /5 in 34 cases, C5/6 in 52 cases, C6/7 in 21 cases. The degree of spinal cord injury according to ASIA classification included grade A in 7 cases, grade B in 48 cases, grade C in 54 cases, grade D in 17 cases. These cases were assessed based on SLIC system, 4 points in 13 cases, 5 points in 24 cases, 6 points in 23 cases, 7 points in 29 cases, 8 points in 17 cases, 9 points in 13 cases and 10 points in 7 cases. According to the three column theory, 45 patients were complicated with anterior and middle column injuries, 13 cases had posterior and middle column injuries, 68 cases had three column injury. All surgeries were decided according to the following factors：injury mechanism in patients with spinal cord compression, morphological characteristics, location and degree of injury. Based on these criteria, 85 cases were operated with anterior operation due to bad general conditions, 7 patients underwent a simple anterior approach rather than combined surgery. 12 cases had posterior operation, among these patients, 2 patients had dislocation of the lower cervical spine with joint locking, the SLIC score was 8. 29 cases used combining-anterior-and-posterior-approach, 1 case had ankylosing spondylitis. According to the score, 4-5 points were classified as mild injury, 6-7 points as moderate injury, 8-10 point as severe injury. Finally, the scores of three groups of patients were summarized and analyzed. Results: The anterior average SLIC score was 5.95+1.31, ranging from 4 to 10. The posterior average score was 6.25+1.29, ranging from 4 to 7, the combined anterior-and-posterior approach group was 8.76+0.83, ranging from 7 to 10. The mild, moderate and severe injuries in the anterior group were 34, 44 and 7 cases respectively, 4-7 points accounted for 92%; the mild, moderate and severe injuries in the posterior group were 4, 6 and 2 cases respectively, 4-7 points accounted for 83%; the mild, moderate and severe injuries in the combined anterior-and-posterior approach group were 0, 1 and 28 cases respectively, 8-10 points accounted for 97%. Conclusions: For single level sub-axial cervical spine injury, combined anterior-and-posterior approach should be considered when the SLIC score is more than 8 or equal to 8. If the SLIC score is 4-7 points, anterior or posterior approach should be considered.