外伤性颈椎间盘突出症的特点与治疗
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作者Author单位AddressE-Mail
苗惊雷 MIAO Jing-lei 中南大学湘雅三医院骨科,湖南 长沙 410013 Department of Orthopaedics,the Third Xiangya Hospital of Centrol South University,Changsha 410013,Hunan,China  
张朝跃 ZHANG Chao-yue 中南大学湘雅三医院骨科,湖南 长沙 410013 Department of Orthopaedics,the Third Xiangya Hospital of Centrol South University,Changsha 410013,Hunan,China zcy1958@medmail.com.cn 
彭智 PENG Zhi 中南大学湘雅三医院骨科,湖南 长沙 410013 Department of Orthopaedics,the Third Xiangya Hospital of Centrol South University,Changsha 410013,Hunan,China  
期刊信息:《中国骨伤》2012年,第25卷,第10期,第817-820页
DOI:10.3969/j.issn.1003-0034.2012.10.008
基金项目:
中文摘要:

目的:总结外伤性颈椎间盘突出症的特点并探讨其手术时机的选择.

方法:2002年6月至2009年6月,对收治的40例外伤性颈椎间盘突出症患者进行回顾性分析,男24例,女16例;年龄30~56岁,平均43.2岁.单节段椎间盘突出36例,双节段突出4例,共44个病变节段,其中C3,4 16个,C4,5 10个,C5,6 12个,C6,7 6个.18例患者伴有脊髓信号改变.5例患者伤后仅表现为颈肩部症状,8例患者同时合并根性症状,10例患者表现为脊髓压迫症状,另17例患者同时出现神经根刺激及脊髓压迫症状.对颈肩痛及合并根性症状的13例患者行保守治疗,5例因效果不佳在伤后6~48 d改行手术,应用Odom标准评价手术疗效.合并脊髓压迫症状的27例患者在伤后1~27 d接受手术,其中16例于伤后5 d内接受手术(早期手术组,JOA评分11.3±2.8),11例于伤后5 d以上接受手术(延迟手术组,JOA评分11.4±2.9),比较两组患者JOA评分恢复率.

结果:5例由保守治疗中转手术患者末次随访时Odom标准评定:优4例,良2例;27例合并脊髓压迫症状患者中早期手术组术后1周JOA评分为(15.3±1.8)分,末次随访为(15.9±1.4)分;延迟手术组术后1周JOA评分为(14.0±2.6)分,末次随访为(15.3±1.5)分.两组患者术后1周及末次随访的JOA评分与术前评分比较差异有统计学意义(P < 0.01).早期手术组患者术后1周JOA评分改善率为(74.6±16.8)%,末次随访为(85.6±13.6)%,延迟手术组患者术后1周JOA评分改善率为(50.9±17.5)%,末次随访为(68.2±21.5)%.两组间术后1周及末次随访JOA评分改善率差异有统计学意义(P < 0.05).

结论:外伤性颈椎间盘突出症在发病节段、临床及影像学表现上有其特殊性;对合并脊髓功能受损的患者,早期手术干预可能有利于神经功能恢复.
【关键词】外伤  颈椎  椎间盘移位  脊髓损伤
 
Characteristics and treatment of traumatic cervical disc herniation
ABSTRACT  

Objective:To explore clinical presentations and the operational opportunity of traumatic cervical disc herniation.

Methods:From June 2002 to June 2009,40 patients with traumatic cervical disc herniation were treated. There were 24 males and 16 females,with an average age of 43.2 years old ranging from 30 to 56 years. There were 36 patients with single intervertebral disc herniation and 4 patients with double. The injury level of those patients were at C3,4 in 16 cases,C4,5 in 10 cases,C5,6 in 12 cases and C6,7 in 6 cases. Among them,18 patients showed spinal cord signal changes by MRI,5 patients suffered from nothing but neck and shoulder pain,8 patients with nerve root stimulation;10 patients with spinal cord compression,and 17 patients had both nerve root stimulation and spinal cord compression symptoms. Conservative treatment were applied to 13 patients with neck and shoulder pain and nerve root stimulation,5 cases of which were transferred to operation in case of poor effects,and Odom criteria were used to assess operational effects. Twenty-seven patients with spinal cord compression accepted operation from 1 to 27days after their trauma,16 of which were operated in 5 days (early operational group with an JOA score of 11.3±2.8),other 11 cases were operated from 5 to 27 days (delayed operational group with an JOA score of 11.4±2.9 ),then functional assessment of spinal cord were assessed according to JOA criteria.

Results:Three patients who were transferred from conservative treatment recovered excellently according to Odom criteria and the other 2 were good at final followed-up. JOA score of early operational group increased from (11.3±2.8) to (15.3±1.8) one week after operation (P < 0.01),and (15.9±1.4) at final followed-up (P < 0.01). JOA score of delayed operational group increased from (11.4±2.9) to (14.0±2.6) one week after operation (P < 0.01),and (15.3±1.5) at final followed-up (P < 0.01). The recovery ratio of JOA score of early operational group were(74.6±16.8)% 1 week after operation,and increased to (85.6±13.6)% at final followed-up;while that of delayed operational group were (50.9±17.5)% and (68.2±21.5)%,and there were significant difference between early operational group and delayed operational group both at 1 week postoperation and final followup (P < 0.05).

Conclusion:There are some difference in pathological segment and imaging manifestation between traumatic cervical disc herniation and cervical spondylosis. Early operation is favorable to the recovery of neurological function in patients with spinal cord compression.
KEY WORDS  Trauma  Cervical vertebrae  Intervertebral disc displacement  Spinal cord injuries
 
引用本文,请按以下格式著录参考文献:
中文格式:苗惊雷,张朝跃,彭智.外伤性颈椎间盘突出症的特点与治疗[J].中国骨伤,2012,25(10):817~820
英文格式:MIAO Jing-lei,ZHANG Chao-yue,PENG Zhi.Characteristics and treatment of traumatic cervical disc herniation[J].zhongguo gu shang / China J Orthop Trauma ,2012,25(10):817~820
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