SLIC评分在下颈椎损伤术式选择中的应用价值

发布时间：2018-05-13 10:29

  本文选题：下颈椎损伤 + 下颈椎损伤分类评分　； 参考：《中国脊柱脊髓杂志》2016年05期

【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。
[Abstract]:Objective: to evaluate the value of sub-axial injury classification (SLICI) score in the selection of surgical methods for lower cervical spine injury. Methods: from January 2009 to September 2013, 126 patients (86 males and 40 females) with single segment lower cervical spine injury were collected. The age was 1672 years old and 46.4 卤4.3 years old. There were 28 cases of falling injury, 62 cases of accident injury, 21 cases of falling injury and 15 cases of falling object injury. Injury site: C3 / 4 19 cases C4 / 534 cases C5 / 6 52 cases C6 / 7 21 cases. The degree of spinal cord injury was classified according to the ASIA standard of American Spinal Cord injury Association. There were 7 cases of grade A, 48 cases of grade B, 54 cases of grade C and 17 cases of grade D. There were 45 cases with anterior column or anterior middle column injury, 13 cases with posterior column injury or middle column injury, and 68 cases with three columns injury. Preoperative SLIC score was performed in 13 cases with 4 points, 24 cases with 5 points, 23 cases with 6 points, 29 cases with 7 points, 17 cases with 8 points, 13 cases with 9 points and 7 cases with 10 points. According to the injury mechanism of the patients, the morphological characteristics of the vertebral body injury, the compression position of the spinal cord and the degree of injury, 85 cases of surgical treatment were selected. Among them, 7 patients with severe injury of three columns, because of the whole body condition can not tolerate the combined operation before and after giving up surgery, choose the simple anterior approach surgery and 12 cases of posterior approach surgery. The SLIC score of 2 cases with articular strangulation was 8 points and 29 cases were treated with anterior and posterior combined operation, and one case was ankylosing spondylitis. According to the degree of injury, the SLIC score of 4 ~ 5 was classified as mild injury and 7 were classified as moderate injury and 8 / 10 as severe injury. The SLIC scores of the three types of operation were analyzed and the rules were summarized. Results: the SLIC score of the patients undergoing anterior approach operation was 5.95 卤1.31 minutes from 4 to 10 minutes, that of the patients with posterior approach was 6.25 卤1.29 minutes from 4 to 8 minutes, and that of the patients with anterior and posterior combined approach was 8.76 卤0.83 minutes and 710 minutes respectively. In the anterior operation group, the scores of severe, moderate and severe injuries were 34-44.The scores of 4 ~ 7 were 922 in the anterior operation group, 4 ~ 6 in the posterior operation group, and 83-7 in the moderate, moderate and severe injury respectively in the posterior approach group, while in the combined anterior and posterior approach operation group, the moderate and severe injuries were 88-10 or 97.In the posterior approach group, 88-10 cases were involved in the severe injury, respectively. Conclusion: for patients with single segment lower cervical spine injury, when the SLIC score is 鈮，

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