發(fā)布時間：2018-06-05 02:53

  本文選題：頸髓損傷 + 無骨折脫位��； 參考：《河北醫(yī)科大學》2015年碩士論文

【摘要】：無骨折脫位型頸髓損傷(Cervical spinal cord injury without fracture and dislocation)即國際上統一命名的無放射影像學異常的頸髓損傷(cervical spinal cord injury without radiographic abnormality,CSCIWORA)是一種特殊類型的脊髓損傷,特指頸部受到外傷后,經X線、CT等檢查手段,頸椎未發(fā)現明顯骨折或脫位的一種臨床常見疾病,占頸髓損傷的37%~52%。此病好發(fā)于兩類人群:兒童及頸椎既往存在病變的成年人。兒童因頸部的椎旁肌肉韌帶、關節(jié)囊等彈性較好,易產生一過性頸部牽拉致頸椎脫位,由于上述原因脫位的頸椎又迅速復原,致頸髓牽拉受傷。對于成人而言,由于既往頸椎存在基礎病變,如椎管狹窄致儲備空間減小、椎間盤膨出或突出以及后縱韌帶鈣化(Ossification of posterior longitudinal ligament,OPLL)等病變,即使輕微的外力也可致頸髓損傷,尤其是頸椎過度后伸及屈曲時,椎管矢狀徑變窄、椎間盤突出加重以及黃韌帶皺褶向椎管內突出都可致脊髓受壓,產生臨床癥狀。由于CSCIWORA的隱匿性以及癥狀滯后性的特點,漏診率較高,且X線、CT無陽性表現,只有通過MRI才能發(fā)現頸髓損傷,因此對臨床醫(yī)師技術水平要求相對較高,如果不及時診斷或者治療方法不得當,都會產生嚴重后果。CSCIWORA的病因仍然沒有研究透徹,多數認為是多種因素共同作用的結果,其最直接的致傷因素多為摔傷、墜落傷以及事故傷等,其共同點是頭頸部受到外力均不大。目前其治療方法多數學者也各抒己見,缺乏理論性依據,本文應用相關評分標準及統計學方法對其治療提供一定的理論依據,為臨床上CSCIWORA的治療起到一定的幫助作用。目的:CSCIWORA采取手術還是非手術治療,目前還存在著一定的爭議,為獲得手術治療的理論依據,本研究旨在對患有CSCIWORA已經實施手術和保守治療的患者在入院時、出院時、出院后三個月和六個月的功能評分對比結果應用統計學方法進行處理,從而得出CSCIWORA的有效治療方法。方法:取自河北醫(yī)科大學第三醫(yī)院創(chuàng)傷急救病區(qū)于2013年8月至2014年10月份收治的CSCIWORA患者總共30例,其中男性共24例,女性共6例,年齡區(qū)間在26歲~66歲,平均年齡為48.1歲。最終門診隨訪10例,電話隨訪20例,除2例予以手術的失訪2例未手術的死亡外,其余26例患者均得到有效隨訪,隨訪期間20個月,并將隨訪到的26例病例分為兩組,A組13例實施手術,B組13例未手術,手術均由我科室主任醫(yī)師在入院后七日內完成。應用日本骨科學會(JOA)評分標準對所有入選病例在入院、出院、三個月、六個月時評分并分別計算出其JOA增加幅度,應用兩獨立樣本t檢驗并對比其結果;然后應用國際脊髓損傷協會(American Spinal Injury Association,ASIA)神經分級標準在入院時和出院后六個月隨訪時進行功能評價,應用秩和檢驗,對所得結果進行分析。結果:對所得結果應用統計學軟件SPSS13.0分析,計量資料用?X±S表示。對A組與B組治療前后JOA評分別行兩獨立樣本t檢驗,入院P0.05(無顯著性差異),出院P0.1;三個月P0.05;六個月P0.05(有顯著性差異)。應用兩獨立樣本t檢驗分別對A組入院時、出院時、三個月、六個月時的JOA評分增加幅度與B組入院時、出院時、三個月、六個月時JOA評分增加幅度相對比,結果P0.05(有顯著性差異)。運用ASIA神經分級標準進行評估,在入院及出院六個月隨訪,并對其神經功能的恢復情況進行等級劃分,并應用Mann-Whitney U秩和檢驗,出院后六個月時P0.05,有統計學意義。在所有入選的病歷中,由于2例患者入院時全癱,脊髓神經功能恢復較差,其余患者均有不同程度的恢復。ASIA分級:A組術前A級1例,B級3例,C級8例,D級1例,E級0例;術后A級0例,B級1例,C級2例,D級8例,E級2例。B組術前A級1例,B級2例,C級7例,D級3例,E級0例;術后A級1例,B級1例,C級7例,D級4例,E級0例。結論:對于CSCIWORA患者,積極手術治療,可給脊髓神經功能早期恢復創(chuàng)造條件,非手術治療對CSCIWORA患者功能恢復療效不明顯,手術可以解除壓迫穩(wěn)定頸椎,對后期脊髓功能恢復十分有利。
[Abstract]:Cervical spinal cord injury (Cervical spinal cord injury without fracture and dislocation) is an internationally unified nomenclature of cervical spinal cord injury without radiological abnormalities (cervical spinal cord injury) is a special type of spinal cord injury, especially after cervical trauma. Line, CT and other methods of examination, the cervical spine has not found a common clinical disease of fracture or dislocation. The 37%~52%. disease, which accounts for the cervical spinal cord injury, occurs in two groups of people: children and adults with previous cervical spondylosis. The flexibility of the paravertebral muscle ligaments and the joint sac of the cervical vertebrae is better, and it is easy to produce a sexual cervical distraction resulting in cervical dislocation. The cervical spine is rapidly restored and caused by cervical pulping injury. For adults, the underlying cervical lesions, such as spinal stenosis, decrease in reserve space, intervertebral disc swelling or protruding, and posterior longitudinal ligament calcification (Ossification of posterior longitudinal ligament, OPLL), even minor external forces It can cause cervical spinal cord injury, especially when the cervical vertebra is overstretched and flexed, the sagittal diameter of the spinal canal is narrowed, the disc herniation is aggravated, and the Yellow toughened fold to the spinal canal can cause the spinal cord compression to produce the clinical symptoms. Due to the concealment of CSCIWORA and the hysteresis of the symptoms, the missed diagnosis rate is high, and the X - ray, CT is not positive, only through MRI. Cervical spinal cord injury can be found, so the technical level of clinicians is relatively high. If not timely diagnosis or treatment is not appropriate, the cause of serious consequences of.CSCIWORA still has no thorough research, most of which are considered to be the result of a variety of factors, and most of the most direct injury factors are falls, falling injuries and things. Therefore, the common point is that the external force of the head and neck is not very large. At present, the methods of treatment for many mathematicians also express their own views and lack theoretical basis. This paper provides a certain theoretical basis for the treatment of CSCIWORA with relevant scoring criteria and statistical methods, which can help the treatment of clinical treatment. Objective: to take the operation of CSCIWORA. In order to obtain the theoretical basis of surgical treatment, the purpose of this study is to provide a theoretical basis for surgical treatment. The purpose of this study is to deal with the functional score comparison of three months and six months after discharge to the patients who have already performed the operation and conservative treatment of CSCIWORA. Methods: RA effective treatment methods. Methods: a total of 30 cases of CSCIWORA patients were treated from August 2013 to October 2014 in Third Hospital of Hebei Medical University. There were 24 cases of male and 6 women. The age range was 26 years old and the average age was 48.1 years. 10 cases were followed up and 20 cases were followed up by telephone, except 2 cases were operated on. The remaining 26 cases were followed up effectively, and the rest of the remaining 2 cases were followed up for 20 months, and 26 cases were divided into two groups, 13 cases in group A were operated, and 13 cases in group B were not operated. All the operations were completed within seven days after the admission by the chief physician of the Department. All selected diseases should be used by the Japanese Department of orthopedics Society (JOA) score standard. The patients were hospitalized, discharged, three months, six months, and calculated the JOA increase, using two independent samples t test and compared the results. Then, the International Spinal Cord Injury Association (American Spinal Injury Association, ASIA) neural grading standard was evaluated at admission and six months after discharge, and the rank was applied. The results were analyzed. Results: the results were analyzed with statistical software SPSS13.0 and X + S for measurement data. The JOA scores of group A and B group were two independent samples t test, P0.05 (no significant difference), discharge P0.1, three month P0.05, six month P0.05 (significant difference). Two independent samples were applied. When the t test was admitted to the group A, the increase of JOA score at three months and six months was compared with that of the group B. The JOA score increased at discharge, three months and six months, and the result was P0.05 (significant difference). The recovery was graded, and the Mann-Whitney U rank sum test was applied to P0.05 after six months of discharge. In all the selected cases, 2 patients were completely paralyzed at admission, the spinal nerve function was poorly restored, and the rest of the patients had different degrees of Restorer.ASIA classification: A group a class a 1 cases, B grade 3 cases, C class 8 cases, D grade. 1 cases, 0 cases of grade E, 0 cases of class A, 1 cases of class B, 2 cases of C class, 8 cases of class D, 2 cases of.B in group E, 2 cases of B, 7 cases of C, 3, E, B level 1, C class, C class, grade, etc. The effect of functional recovery is not obvious. Surgery can relieve compression and stabilize the cervical vertebra, which is beneficial to the recovery of spinal cord function in the later stage.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R651.2

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