无骨折脱位颈脊髓损伤并发前柱软组织损伤的疾病特点及疗效分析

发布时间：2018-06-13 06:07

本文选题：无骨折脱位颈脊髓损伤 + 颈椎前柱软组织　；参考：《吉林大学》2015年硕士论文

【摘要】：目的：探究无骨折脱位颈脊髓损伤合并颈椎前柱软组织结构损伤患者发病特点及手术疗效分析。方法：回顾性分析我科自2012年12月-2014年7月间收治的临床资料完整的无骨折脱位型颈脊髓损伤患者71例，所有患者均术前行X线、MRI检查。按照MRI上显示前纵韧带T2加权像横行高信号（T2T）、T2加权像间盘异常高信号作为急性期颈椎前柱软组织结构可疑损伤标准，具备其中之一即认为前柱软组织损伤具有探查手术指证。手术行前路或前后路手术，探查到可疑损伤节段，并对明确损伤节段予以稳定手术处理。术中明确发现前柱软组织损伤患者42例，记录为损伤组。其余29例为非损伤组。术中所见前纵韧带、间盘损伤情况详细记录。比较损伤组与非损伤组在年龄、受伤因素、颈椎曲度减小、椎前阴影增宽、JOA评分及JOA改善率。结果：损伤组42例。非损伤组29例。其中损伤组男性35人，女性7例。非损伤组男性20人，女性9人。随访3个月-25个月，平均随访18.1个月。损伤组平均年龄48.2岁，非损伤组53.1岁，青年、中年、老年见比例在损伤组分别是16.67%、76.19%、7.14%，非损伤组分别是6.9%、62.07%、31.03%。致伤因素中车祸、摔伤、高处坠落、重物砸伤、其他在损伤组比例17%、38%、19%、21%、5%,非损伤组比例41%、31%、4%、24%、0%。术前颈椎曲度：损伤组（5.07±3.12）mm，非损伤组（5.39±4.22）mm。损伤组中颈椎曲度变直36例，占85.71%。非损伤组19例，占65.52%。P＜0.05，差别有统计学意义。X线椎前阴影增宽：损伤组40例，占95.24%。非损伤组22例，占75.86%。P＜0.05，差别有统计学意义。损伤组JOA评分从4.67±3.04提高到11.50±4.32，改善率62.35%±17.34%；非损伤组JOA评分从5.02±4.06提高到12.67±4.21，改善率65.96%±19.22%。两组组内术后与术前JOA比较P＜0.05，差别有统计学意义，即两组病人手术后神经功能均获得明显改善;两组间前、术后JOA及JOA改善率比较均P＜0.05,差别有统计学意义，即损伤组伤后神经功能较未损伤组神经功能损伤严重，且术后神经功能恢复较无椎前软组织损伤的较差。结论：无骨折脱位颈脊髓损伤合并前柱软组织损伤发病年龄较为损伤者偏小，，颈椎曲度减小可能是前置因素；摔伤、重物砸伤、高处坠落伤为主要致伤因素，伤后椎前软组织阴影增宽明显；合并前柱软组织损伤的神经损伤较未损伤患者较重，但是及早期手术，神经功能仍可获得一定程度恢复。
[Abstract]:Objective: to investigate the characteristics of cervical spinal cord injury and anterior column soft tissue structure injury without fracture and dislocation. Methods: a total of 71 patients with cervical spinal cord injury without fracture and dislocation were retrospectively analyzed from December 2012 to July 2014. All patients underwent X-ray MRI before operation. According to T2-weighted imaging of anterior longitudinal ligament on MRI, the abnormal high signal intensity of T _ 2T _ (2) T _ (2) T _ (2) weighted disc was regarded as the standard of suspicious injury of soft tissue structure of anterior column of cervical spine in acute stage, and one of them was that the injury of anterior column soft tissue had exploratory surgical indication. The suspicious injury segment was detected by anterior or posterior approach, and the definite injury segment was treated stably. 42 cases of anterior column soft tissue injury were clearly found during operation, recorded as injury group. The other 29 cases were non-injury group. The injury of anterior longitudinal ligament and disc was recorded in detail. The age, injury factors, cervical curvature, JOA score and JOA improvement rate were compared between the injury group and the non-injury group. Results: 42 cases in injury group. There were 29 cases in non-injury group. There were 35 males and 7 females in the injury group. There were 20 males and 9 females in the non-injury group. The patients were followed up for 3 months to 25 months, with an average follow-up of 18.1 months. The average age of the injury group was 48.2 years old, and that of the non-injury group was 53.1 years old, youth, middle age and old age. In the injury group, the proportion was 16.67 and 76.197.14, respectively. In the non-injury group, it was 6.9 and 62.07, respectively, and that in the non-injury group was 31.03. Among the causes of injury were car accidents, falls, falls from high places, heavy objects falling, others in the injury group (17 / 38) and in the injury group (41 / 41) and in the non-injury group (41 / 41). The curvature of cervical spine before operation was 5.07 卤3.12mm in the injury group and 5.39 卤4.22mm in the non-injury group. In the injury group, 36 cases (85.71%) had cervical curvature straightening. There were 19 cases (65.52%) in non-injury group (P < 0.05). The difference was statistically significant (P < 0.05). There were 40 cases (95.24%) in the injury group and 40 cases (95.24%) in the injury group. 22 cases (75.86%, P < 0.05) in non-injury group, the difference was statistically significant. The JOA score in the injury group was increased from 4.67 卤3.04 to 11.50 卤4.32, and the improvement rate was 62.35% 卤17.34, while in the non-injury group, the JOA score increased from 5.02 卤4.06 to 12.67 卤4.21, and the improvement rate was 65.96% 卤19.22. There was a significant difference between the two groups in postoperative JOA and preoperative JOA (P < 0.05), that is, the nerve function of the two groups was significantly improved after operation, and the improvement rates of JOA and JOA were significantly different between the two groups before and after operation (P < 0.05), there was significant difference between the two groups in the improvement rate of JOA and JOA after operation (P < 0.05). The nerve function of the injured group was more serious than that of the uninjured group, and the recovery of postoperative nerve function was worse than that of the non-prevertebral soft tissue injury. Conclusion: the onset age of cervical spinal cord injury without fracture and dislocation combined with anterior column soft tissue injury is relatively small, and the reduction of cervical spine curvature may be the leading factor, falling injury, heavy object injury and falling injury from height are the main causes of injury. The nerve injury with anterior column soft tissue injury was more serious than that without injury, but the nerve function could still recover to some extent after early operation.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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