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

【摘要】：無(wú)骨折脫位型頸髓損傷(Cervical spinal cord injury without fracture and dislocation)即國(guó)際上統(tǒng)一命名的無(wú)放射影像學(xué)異常的頸髓損傷(cervical spinal cord injury without radiographic abnormality,CSCIWORA)是一種特殊類(lèi)型的脊髓損傷,特指頸部受到外傷后,經(jīng)X線(xiàn)、CT等檢查手段,頸椎未發(fā)現(xiàn)明顯骨折或脫位的一種臨床常見(jiàn)疾病,占頸髓損傷的37%~52%。此病好發(fā)于兩類(lèi)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(guān)節(jié)囊等彈性較好,易產(chǎn)生一過(guò)性頸部牽拉致頸椎脫位,由于上述原因脫位的頸椎又迅速?gòu)?fù)原,致頸髓牽拉受傷。對(duì)于成人而言,由于既往頸椎存在基礎(chǔ)病變,如椎管狹窄致儲(chǔ)備空間減小、椎間盤(pán)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(guò)度后伸及屈曲時(shí),椎管矢狀徑變窄、椎間盤(pán)突出加重以及黃韌帶皺褶向椎管內(nèi)突出都可致脊髓受壓,產(chǎn)生臨床癥狀。由于CSCIWORA的隱匿性以及癥狀滯后性的特點(diǎn),漏診率較高,且X線(xiàn)、CT無(wú)陽(yáng)性表現(xiàn),只有通過(guò)MRI才能發(fā)現(xiàn)頸髓損傷,因此對(duì)臨床醫(yī)師技術(shù)水平要求相對(duì)較高,如果不及時(shí)診斷或者治療方法不得當(dāng),都會(huì)產(chǎn)生嚴(yán)重后果。CSCIWORA的病因仍然沒(méi)有研究透徹,多數(shù)認(rèn)為是多種因素共同作用的結(jié)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(diǎn)是頭頸部受到外力均不大。目前其治療方法多數(shù)學(xué)者也各抒己見(jiàn),缺乏理論性依據(jù),本文應(yīng)用相關(guān)評(píng)分標(biāo)準(zhǔn)及統(tǒng)計(jì)學(xué)方法對(duì)其治療提供一定的理論依據(jù),為臨床上CSCIWORA的治療起到一定的幫助作用。目的:CSCIWORA采取手術(shù)還是非手術(shù)治療,目前還存在著一定的爭(zhēng)議,為獲得手術(shù)治療的理論依據(jù),本研究旨在對(duì)患有CSCIWORA已經(jīng)實(shí)施手術(shù)和保守治療的患者在入院時(shí)、出院時(shí)、出院后三個(gè)月和六個(gè)月的功能評(píng)分對(duì)比結(jié)果應(yīng)用統(tǒng)計(jì)學(xué)方法進(jìn)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(xué)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(mén)診隨訪(fǎng)10例,電話(huà)隨訪(fǎng)20例,除2例予以手術(shù)的失訪(fǎng)2例未手術(shù)的死亡外,其余26例患者均得到有效隨訪(fǎng),隨訪(fǎng)期間20個(gè)月,并將隨訪(fǎng)到的26例病例分為兩組,A組13例實(shí)施手術(shù),B組13例未手術(shù),手術(shù)均由我科室主任醫(yī)師在入院后七日內(nèi)完成。應(yīng)用日本骨科學(xué)會(huì)(JOA)評(píng)分標(biāo)準(zhǔn)對(duì)所有入選病例在入院、出院、三個(gè)月、六個(gè)月時(shí)評(píng)分并分別計(jì)算出其JOA增加幅度,應(yīng)用兩獨(dú)立樣本t檢驗(yàn)并對(duì)比其結(jié)果;然后應(yīng)用國(guó)際脊髓損傷協(xié)會(huì)(American Spinal Injury Association,ASIA)神經(jīng)分級(jí)標(biāo)準(zhǔn)在入院時(shí)和出院后六個(gè)月隨訪(fǎng)時(shí)進(jìn)行功能評(píng)價(jià),應(yīng)用秩和檢驗(yàn),對(duì)所得結(jié)果進(jìn)行分析。結(jié)果:對(duì)所得結(jié)果應(yīng)用統(tǒng)計(jì)學(xué)軟件SPSS13.0分析,計(jì)量資料用?X±S表示。對(duì)A組與B組治療前后JOA評(píng)分別行兩獨(dú)立樣本t檢驗(yàn),入院P0.05(無(wú)顯著性差異),出院P0.1;三個(gè)月P0.05;六個(gè)月P0.05(有顯著性差異)。應(yīng)用兩獨(dú)立樣本t檢驗(yàn)分別對(duì)A組入院時(shí)、出院時(shí)、三個(gè)月、六個(gè)月時(shí)的JOA評(píng)分增加幅度與B組入院時(shí)、出院時(shí)、三個(gè)月、六個(gè)月時(shí)JOA評(píng)分增加幅度相對(duì)比,結(jié)果P0.05(有顯著性差異)。運(yùn)用ASIA神經(jīng)分級(jí)標(biāo)準(zhǔn)進(jìn)行評(píng)估,在入院及出院六個(gè)月隨訪(fǎng),并對(duì)其神經(jīng)功能的恢復(fù)情況進(jìn)行等級(jí)劃分,并應(yīng)用Mann-Whitney U秩和檢驗(yàn),出院后六個(gè)月時(shí)P0.05,有統(tǒng)計(jì)學(xué)意義。在所有入選的病歷中,由于2例患者入院時(shí)全癱,脊髓神經(jīng)功能恢復(fù)較差,其余患者均有不同程度的恢復(fù)。ASIA分級(jí):A組術(shù)前A級(jí)1例,B級(jí)3例,C級(jí)8例,D級(jí)1例,E級(jí)0例;術(shù)后A級(jí)0例,B級(jí)1例,C級(jí)2例,D級(jí)8例,E級(jí)2例。B組術(shù)前A級(jí)1例,B級(jí)2例,C級(jí)7例,D級(jí)3例,E級(jí)0例;術(shù)后A級(jí)1例,B級(jí)1例,C級(jí)7例,D級(jí)4例,E級(jí)0例。結(jié)論:對(duì)于CSCIWORA患者,積極手術(shù)治療,可給脊髓神經(jīng)功能早期恢復(fù)創(chuàng)造條件,非手術(shù)治療對(duì)CSCIWORA患者功能恢復(fù)療效不明顯,手術(shù)可以解除壓迫穩(wěn)定頸椎,對(duì)后期脊髓功能恢復(fù)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(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R651.2

【參考文獻(xiàn)】

相關(guān)期刊論文 前7條

1 常青;鄧展生;陳靜;;中青年頸椎無(wú)骨折脫位的急性頸脊髓中央型損傷的手術(shù)效果[J];南方醫(yī)科大學(xué)學(xué)報(bào);2011年05期

2 戴力揚(yáng),蔣雷生,張家紅,崔一民;急性中央頸脊髓損傷臨床表現(xiàn)的多樣性與不典型性[J];骨與關(guān)節(jié)損傷雜志;2003年09期

3 姚建華,胥少汀,時(shí)述山,季新民,劉樹(shù)清;無(wú)放射影像異常頸脊髓損傷的治療與預(yù)后[J];中華骨科雜志;1997年05期

4 陳學(xué)明;許崧杰;劉亞?wèn)|;崔利賓;朱旭;于振山;王德成;;無(wú)骨折脫位型頸脊髓損傷治療方法的探討[J];中國(guó)矯形外科雜志;2011年08期

5 孫宇,蔡欽林,王立舜,王少波,黨耕町;無(wú)骨折脫位型頸脊髓損傷外科治療隨診觀(guān)察[J];中國(guó)脊柱脊髓雜志;2002年02期

6 張力成;急性外傷性無(wú)骨折脫位型頸脊髓損傷的神經(jīng)電圖表現(xiàn)[J];中國(guó)修復(fù)重建外科雜志;1998年03期

7 孫宇;;對(duì)頸椎前路融合與非融合手術(shù)混合應(yīng)用的初步認(rèn)識(shí)[J];中國(guó)脊柱脊髓雜志;2014年01期

，

本文編號(hào)：1980132