沈迎春 邹德波

【摘 要】目的：探讨手术与非手术治疗无骨折脱位型颈髓损伤的临床效果。 方法：回顾性分析41例无骨折脱位型颈髓损伤病例，其中19例行非手术治疗，22例行手术治疗，比较两组患者治疗前后ASIA损害分级、JOA评分及神经功能改善情况，评价治疗效果。 结果：非手术组和手术组治疗后ASIA损害分级、JOA评分均较治疗前提高；手术组治疗后3月及12月时神经功能改善率分别为（40±21）%和（59±30）%，非手术组同期神经改善率为（26±13）%和（42±27）%，手术组比非手术组神经功能改善明显，差异具有显著性意义（P﹤0.05）。 结论：手术与非手术均能较好的治疗无骨折脱位型颈髓损伤，但手术治疗效果更为确切。

【关键词】无骨折脱位；颈髓损伤；治疗；疗效

【中图分类号】R651.2 【文献标识码】A 【文章编号】1004-7484（2014）06-3472-02

The Clinical outcomes of Operative and non-operative Methods in the treatment of the

cervical spinal cord injury without fracture and dislocation

SHEN Ying-chun， ZOU De-bo*

（ *Department of Spine， Shandong Provincial Qianfoshan Hospital， Shandong University， Jinan 250014， P.R. China）

【Abstract】 Objective：To discuss the clinical outcomes of operative and non-operative methods in the treatment of cervical spinal cord injury without fracture and dislocation. Methods：The total of 45 patients with cervical spinal cord injury without fracture and dislocation treated were retrospectively analyzed， including 21 patients treated non-operatively， 24 patients treated operatively. The ASIA impairment scale and JOA scores of the two groups were compared， clinical effects were observed. Results：The ASIA impairment scale and JOA scores of the non-operative and operative groups were improved significantly compared to those of non-treatment. The curative probability of nerve function of the operative group in 3 month and 12 month after treatment was （40±21）% and （59±30）% respectively， while those of non-operative group in the same time was （26±13）% and （42±27）% respectively. The operative group got better nerve function than that of the non-operative group， and the difference between the two groups was significant statistically. Conclusions：The methods of both operative and non-operative could get better clinical outcomes in the treatment of patients of cervical spinal cord injury without fracture and dislocation， however， the operation is preferable.

【key words】Non fracture or dislocation； Cervical spinal cord injury； Treatment； Clinical outcomes

近年來，由于交通事故等事件频发，颈椎颈髓损伤日益增多。随着影像学技术的发展，无骨折脱位型颈髓损伤已经能够被早期诊断和治疗，但目前对于治疗方法仍存有一定争论[1-2]。本文分析了我院自2007年5月至2012年5月间治疗的一组病例，对手术与非手术治疗及其效果进行探讨。

1 资料与方法

1.1 一般资料

本组收集临床资料完整的无骨折脱位型颈髓损伤病例共41例。其中男性29例，女性12例；年龄20-66岁，平均47岁。受伤原因：车祸伤24例，高处坠落伤8例，重物砸伤5例，跌倒摔伤4例。按受力机制划分，过伸性损伤30例，屈曲性损伤11例。伤后至就诊时间为3小时-3周，随机分为两组，非手术治疗19例，手术治疗22例。随访12-35个月，平均17个月。

1.2 临床表现

患者在伤前均无神经系统症状，伤后出现颈髓损伤的临床表现。……