脊髓型颈椎病无骨折脱位脊髓损伤三种治疗的比较

Comparison of three treatments for cervical spinal cord injury without major fracture or dislocation in patients with preexisting cervical spinal canal stenosis

摘要:

［目的］比较三种治疗无骨折脱位颈脊髓损伤（cervical spinal cord injury without major fracture or dislocation, CSCI）合并脊髓型颈椎病（cervical spinal canal stenosis, CSCS）的临床效果。［方法］2015 年 3 月—2020 年 3 月，144 例 CSCI 合并 CSCS 患者纳入本研究。依据术前医患沟通结果，51 例行前路组减压术，44 例行后路减压术、49 例行保守治疗。比较三组患者临床与影像资料。［结果］三组患者均顺利完成治疗，无神经损害症状加重，均无死亡等严重并发症。前路组手术时间、术中出血量均显著优于后路组 （P<0.05）。随时间推移，三组患者 ASIA 神经功能评级均显著改善 （P<0.05），JOA 评分显著增加 （P< 0.05）。术后 3、12 个月时，ASIA 评级和 JOA 评分从优至劣均依次为：前路组、后路组和保守组，组间差异均有统计学意义 （P<0.05）。与术前相比，术后前路组与后路组的 C_2~7 Cobb 角和椎管面积均显著增加 （P<0.05），但是，保守组不同时间点间 C_2~7 Cobb 角和椎管面积均无显著变化（P>0.05）。［结论］本研究中，前路减压手术治疗 CSCI 合并 CSCS 的临床效果最佳。

Abstract:

[Objective] To compare three treatments for cervical spinal cord injury (CSCI) without major fracture or dislocation in pa- tients with pre exiting cervical spinal canal stenosis (CSCS) . [Methods] From March 2015 to March 2020, 144 patients with CSCI com- bined with CSCS were enrolled in this study. According to the results of preoperative doctor-patient communication, 51 patients underwent anterior decompression, 44 patients underwent posterior decompression, and 49 patients received conservative treatment. The clinical and imaging data of the three groups were compared. [Results] All the patients in the three groups successfully completed the treatment, without aggravation of neurological symptoms and death. The anterior group proved significantly superior to the posterior group in terms of operative time and intraoperative blood loss (P＜0.05) . The ASIA neurological function grades and JOA score improved significantly over time in all three groups (P＜0.05) . At 3 and 12 months later, ASIA and JOA score ranked from superior to inferior were as follows: anterior approach group, posterior approach group and conservative group, with statistically significant differences (P＜0.05) . Compared with those preopera- tively, the C2~7 Cobb angle and spinal canal area significantly increased in anterior and posterior approaches (P＜0.05) , whereas remained unchanged among different time points in the conservative group (P＞0.05) . [Conclusion] Anterior decompression achieve the best out- comes for CSCI combined with CSCS in this study .