急性创伤性中央颈髓综合征手术治疗的预后因素分析

Prognostic factors of surgical treatment for acute traumatic central cord syndrome

中文关键词:  急性创伤性中央颈髓综合征  颈椎手术  预后  颈脊髓损伤

英文关键词:Acute traumatic central cord syndrome  Cervical surgery  Prognosis  Spinal cord injury

中文摘要:

  【摘要】 目的：探讨急性创伤性中央颈髓综合征（ATCCS）手术治疗的有效性，分析影响术后脊髓功能恢复的因素。方法：回顾2015年～2017年我院骨科手术治疗的53例ATCCS患者的临床资料，包括年龄、性别、是否存在病理征、入院手内肌肌力、是否存在椎旁软组织损伤、脊髓内高信号长度、椎管最狭窄处百分比（MCC）、脊髓最大受压程度（MSCC）、手术时机、手术入路、入院和末次随访ASIA评分（运动、感觉）、JOA评分等信息，分析影响术后脊髓功能恢复的因素。结果：53例患者平均年龄55.57±9.68岁，39例男性（74%），14例女性（26%），伤后平均6.85±5.39天接受手术治疗，其中前路手术19例，后路手术34例，术后平均随访21.51±10.46个月；入院ASIA运动评分70.43±23.32分、ASIA感觉评分99.21±11.78分、JOA评分9.87±2.96分，末次随访ASIA运动评分92.17±13.16分、ASIA感觉评分105.77±6.79分、JOA评分14.13±3.14分，均较入院明显增加（P＜0.05），脊髓功能明显恢复。根据JOA评分改善率分组（＞50%定义为预后好39例，≤50%定义为预后差14例）并进行相关因素分析，结果显示高龄（61.14±7.55 vs 53.56±9.65岁）、入院手内肌肌力较差（5.43±5.95 vs 9.49±4.99分）、病理征阳性（阳性/阴性）（10/4 vs 15/24例），MRI T2像显示存在椎旁软组织损伤（有/无）（8/6 vs 9/30例）及脊髓内高信号长度较长（25.87±13.85mm vs 18.08±10.68mm）是预后差的主要因素（P＜0.05）。而性别（男/女）（29/10 vs 10/4例）、MCC[（43.18±10.96）% vs （49.14±7.94）%]、MSCC[（26.75±10.81）% vs （28.67±9.59）%]、入院ASIA运动评分（74.18±22.78 vs 60.00±22.35分）、入院ASIA感觉评分（101.38±8.93 vs 93.14±16.38分）、手术时机（7.51±5.87 vs 5.00±3.23分）、手术入路（前路/后路）（15/24 vs 4/10例）对预后无明显影响（P＞0.05）。结论：ATCCS采用手术治疗安全有效；高龄、病理征阳性、入院手内肌评分低、椎旁软组织有损伤、脊髓内高信号长度长提示患者术后脊髓功能恢复差。

英文摘要:

  【Abstract】 Objectives: To investigate the effectiveness of surgical treatment of acute traumatic central cord syndrome(ATCCS), and to analyze the factors of affecting postoperative spinal cord function recovery. Methods: Totally 53 patients with ATCCS who underwent orthopedic surgical treatment in our hospital from 2015 to 2017 were reviewed, including age, gender, pathological signs, intrinsic muscle strength of hand at admission, paravertebral soft tissue injury, the length of high signal in spinal cord, maximum canal compromise(MCC), maximum spinal cord compression(MSCC), the interval from injury to surgery, surgical approach, the ASIA score(motor, sensory) and JOA score at admission and the final follow-up. The factors of affecting postoperative spinal cord function recovery were analyzed. Results: In the cohort of 53 patients, the mean age was 55.57±9.68 years, 39 patients were males(74%), 14 patients were females(26%). The average interval from injury to surgery was 6.85±5.39 days. 19 cases underwent anterior surgery, 34 cases underwent posterior surgery. The results showed that the old age(61.14±7.55 vs 53.56±9.65 years old), the intrinsic muscle strength of hand was poor(5.43±5.95 vs 9.49±4.99 points), pathological signs were positive(positive/negative)(10/4 vs 15/24 cases), the T2-weighted MR showed paravertebral soft tissue injury(8/6 vs 9/30 cases) and long length of high signal in spinal cord(25.87±13.85mm vs 18.08±10.68mm) were the main factors for poor prognosis(P<0.05). And gender(29/10 vs 10/4 cases), MCC[(43.18±10.96)% vs (49.14±7.94)%], MSCC[(26.75±10.81)% vs (28.67±9.59)%], admission ASIA motor score(74.18±22.78 vs 60.00±22.35 points), admission ASIA sensory score(101.38±8.93 vs 93.14±16.38 points), the interval from injury to surgery(7.51±5.87 vs 5.00±3.23 points), surgical approach(15/24 vs 4/10 cases) had no significant effect on prognosis(P>0.05). Conclusions: Surgical treatment is safe and effective for ATCCS. Advanced age, positive pathology, low intrinsic muscle strength of hand at admission, injured paravertebral soft tissue and long high signal length in spinal cord indicate that the spinal cord function recovery is poor after operation.