本文選題：無骨折脫位頸脊髓損傷 + 頸椎前柱軟組織�。� 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：目的：探究無骨折脫位頸脊髓損傷合并頸椎前柱軟組織結(jié)構(gòu)損傷患者發(fā)病特點(diǎn)及手術(shù)療效分析。 方法：回顧性分析我科自2012年12月-2014年7月間收治的臨床資料完整的無骨折脫位型頸脊髓損傷患者71例，所有患者均術(shù)前行X線、MRI檢查。按照MRI上顯示前縱韌帶T2加權(quán)像橫行高信號（T2T）、T2加權(quán)像間盤異常高信號作為急性期頸椎前柱軟組織結(jié)構(gòu)可疑損傷標(biāo)準(zhǔn)，具備其中之一即認(rèn)為前柱軟組織損傷具有探查手術(shù)指證。手術(shù)行前路或前后路手術(shù)，探查到可疑損傷節(jié)段，并對明確損傷節(jié)段予以穩(wěn)定手術(shù)處理。術(shù)中明確發(fā)現(xiàn)前柱軟組織損傷患者42例，記錄為損傷組。其余29例為非損傷組。術(shù)中所見前縱韌帶、間盤損傷情況詳細(xì)記錄。比較損傷組與非損傷組在年齡、受傷因素、頸椎曲度減小、椎前陰影增寬、JOA評分及JOA改善率。 結(jié)果：損傷組42例。非損傷組29例。其中損傷組男性35人，女性7例。非損傷組男性20人，女性9人。隨訪3個(gè)月-25個(gè)月，平均隨訪18.1個(gè)月。損傷組平均年齡48.2歲，非損傷組53.1歲，青年、中年、老年見比例在損傷組分別是16.67%、76.19%、7.14%，非損傷組分別是6.9%、62.07%、31.03%。致傷因素中車禍、摔傷、高處墜落、重物砸傷、其他在損傷組比例17%、38%、19%、21%、5%,非損傷組比例41%、31%、4%、24%、0%。術(shù)前頸椎曲度：損傷組（5.07±3.12）mm，非損傷組（5.39±4.22）mm。損傷組中頸椎曲度變直36例，占85.71%。非損傷組19例，占65.52%。P＜0.05，差別有統(tǒng)計(jì)學(xué)意義。X線椎前陰影增寬：損傷組40例，占95.24%。非損傷組22例，占75.86%。P＜0.05，差別有統(tǒng)計(jì)學(xué)意義。損傷組JOA評分從4.67±3.04提高到11.50±4.32，改善率62.35%±17.34%；非損傷組JOA評分從5.02±4.06提高到12.67±4.21，改善率65.96%±19.22%。兩組組內(nèi)術(shù)后與術(shù)前JOA比較P＜0.05，差別有統(tǒng)計(jì)學(xué)意義，即兩組病人手術(shù)后神經(jīng)功能均獲得明顯改善;兩組間前、術(shù)后JOA及JOA改善率比較均P＜0.05,差別有統(tǒng)計(jì)學(xué)意義，即損傷組傷后神經(jīng)功能較未損傷組神經(jīng)功能損傷嚴(yán)重，且術(shù)后神經(jīng)功能恢復(fù)較無椎前軟組織損傷的較差。 結(jié)論：無骨折脫位頸脊髓損傷合并前柱軟組織損傷發(fā)病年齡較為損傷者偏小，，頸椎曲度減小可能是前置因素； 摔傷、重物砸傷、高處墜落傷為主要致傷因素，傷后椎前軟組織陰影增寬明顯； 合并前柱軟組織損傷的神經(jīng)損傷較未損傷患者較重，但是及早期手術(shù)，神經(jīng)功能仍可獲得一定程度恢復(fù)。
[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 鹵3.12mm in the injury group and 5.39 鹵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 鹵3.04 to 11.50 鹵4.32, and the improvement rate was 62.35% 鹵17.34, while in the non-injury group, the JOA score increased from 5.02 鹵4.06 to 12.67 鹵4.21, and the improvement rate was 65.96% 鹵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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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本文編號：2013003