颈椎退变对外伤性颈髓损伤的影响

目的:探讨颈椎退变因素对外伤性颈髓损伤的影响。方法:选择2009年1月到2010年12月手术治疗的24例无明显骨折脱位的颈髓外伤患者进行回顾性分析,其中男16例,女8例;年龄46～70岁,平均59.1岁。根据术前颈椎退变程度将其分为轻度退变组(6例),中度退变组(10例),重度退变组(8例)。用日本骨科学会JOA评分比较患者术前神经功能损伤及术后神经功能恢复情况;用SF-36量表测定及评价患者术前、术后生活质量。结果:24例患者均获随访,时间4～16个月,平均12个月。轻、中、重度退变组术前JOA评分均值分别为12.1±1.5,10.3±1.8,7.3±1.0,术后3个月分别提高为16.3±1.0,15.3±1.4,13.0±2.3,JOA评分提示中远期神经功能改善率良好程度依次为轻度退变组(85.7%)>中度退变组(74.6%)>重度退变组(58.8%);SF-36量表8个维度测定提示术前生活质量良好程度依次轻度退变组>中度退变组>重度退变组,术后3个月生活质量良好程度依次为轻度退变组>中度退变组>重度退变组,两两间比较差异均有统计学意义(P<0.05)。结论:颈椎退变是外伤性颈髓损伤的重要病理基础和危险因素,退变的严重程度直接影响患者神经功能损伤程度及预后,两者关系在临床上应当引起足够的重视。

Effects of cervical vertebrae degeneration on traumatic cervical cord injury

Objective: To evaluate the effects of cervical vertebrae degeneration on traumatic cervical cord injury. Methods: From January 2009 to December 2010,24 patients with cervical cord injury without obvious fractures and dislocations were treated with operation,and their data were retrospectively analyzed. Among them,16 males and 8 females,aged from 46 to 70 years old with an average of 59.1 years. Patients were divided into light degeneration group(6 cases),moderate degeneration group (10 cases) and severe degeneration group(8 cases),according to the preoperative degenerative degree of cervical vertebrae. Preoperative neurological dysfunction and postoperative neurological recovery were compared according to the JOA scores of Japanese Orthopaedic Society;quality of life were evaluated according to SF-36 scale (36-item Short Form Health Survey,SF-36). Results: All patients were followed up from 4 to 16 months with an average of 12 months. The JOA score of light,moderate,severe degeneration group were 12.1±1.5,10.3± 1.8,7.3±1.0,respectively;and were respectively increased to 16.3±1.0,15.3±1.4,13.0±2.3 at the 3 months after operation. Postoperative JOA score showed the improvement rate of mid-long-term neurological level was light degeneration group (89.8%)> moderate degeneration group (76.6%)> severe degeneration group(58.8%). The results of preoperative SF-36 scale showed light degeneration group>moderate degeneration group>severe degeneration group;there was significant difference in comparison of two groups(P < 0.05 ). Conclusion: Cervical degeneration is an important pathologic basis and risk factor in traumatic cervical cord injury,and the degenerative degree will directly influence the injury degree and prognosis of neurological function,the clinical relationship between them should be sufficiently paid attention to.