伴頸神經(jīng)根病的無癥狀頸椎退變性脊髓壓迫的治療

·臨床研究·

伴頸神經(jīng)根病的無癥狀頸椎退變性脊髓壓迫的治療

尹國棟，羅劍，陳觀華，蒲曉斌，郭珊成，黃志勇，何平，薛超，陳菜鳳

作者單位：524005廣東，解放軍第422醫(yī)院脊柱外科

【摘要】目的探討伴頸神經(jīng)根病的無癥狀頸椎退變性脊髓壓迫(asymptomatic spondylotic cervical cord compression, A-SCCC)的治療。方法回顧分析本院2009年6月～2012年6月收治的34例伴頸神經(jīng)根病的A-SCCC患者病例資料，患者入院后先接受系統(tǒng)的非手術(shù)治療，如果神經(jīng)功能無緩解或加重，則行手術(shù)治療，收集患者一般情況及影像學(xué)資料，于治療前后不同時(shí)間點(diǎn)通過日本骨科學(xué)會(Japanese Orthopaedic Association, JOA)評分評價(jià)臨床治療效果。結(jié)果34例患者平均隨訪4個(gè)月，其中23例經(jīng)非手術(shù)治療獲得不同程度的改善；11例改善不明顯，其中8例改手術(shù)治療，3例患者繼續(xù)非手術(shù)治療(2例癥狀逐漸緩解，1例出現(xiàn)脊髓病臨床表現(xiàn))。治療后及隨訪期間非手術(shù)組與手術(shù)組患者JOA評分均較治療前明顯改善，差異有統(tǒng)計(jì)學(xué)意義(P<0.01)。結(jié)論多數(shù)伴頸神經(jīng)根病的A-SCCC患者經(jīng)過系統(tǒng)非手術(shù)治療后病情可以緩解，部分仍需手術(shù)治療，伴頸神經(jīng)根病或脊髓高信號的A-SCCC不必預(yù)防性手術(shù)，但需密切觀察病情變化。

【關(guān)鍵詞】頸椎; 脊髓壓迫癥; 神經(jīng)根病; 椎間盤退行性變; 臨床方案

作者簡介：尹國棟(1978— )， 博士，主治醫(yī)師

【中圖分類號】R 744.2【文獻(xiàn)標(biāo)志碼】 A

DOI【】

收稿日期：(2013-12-20)

Treatment of asymptomatic spondylotic cervical cord compression combined with symptomatic cervical radiculopathy

YINGuo-dong,LUOJian,CHENGuang-hua,PUXiao-bin,GUOShan-cheng,HUANGZhi-yong,HEPing,XUEChao,CHENCai-feng.DepartmentofSpinalSurgery, 422ndHospitalofPeople'sLiberationArmy,Zhanjiang524005,Guangdong,China

Abstract【】ObjectiveTo investigate therapeutic methods of asymptomatic spondylotic cervical cord compression (A-SCCC) combined with symptomatic cervical radiculopathy. MethodsFrom June 2009 to June 2012，34 patients with A-SCCC combined with symptomatic cervical radiculopathy were included in this retrospective analysis. All the cases underwent anterior-posterior, lateral, excessive flexion and extension cervical spine X-ray and MRI. Age, gender, duration of disease and the Pavlov ratio were also collected. Conservative treatment to all patients accepted after admission system, the patients were underwent surgical operation without neural function recovery after normal conservative treatment. Before treatment and at different time points after treatment, the Japanese Orthopaedic Association (JOA) scores were calculated to evaluate the clinical effect of treatment. ResultsAll of 34 patients were followed up for an average of 4 months, of which 23 patients got different degrees of neural function improvements after conservative treatment, and 11 patients had no obvious improvement. Eight cases without obvious improvement underwent operation, and other 3 patients refused operation treatment of who 2 cases were relieved after continued conservative treatment, and the remaining 1 case developed with clinical manifestations of spinal cord disease. The JOA scores in both groups were significantly improved after treatment (P<0.01). Conclusion Majority of patients with A-SCCC combined with symptomatic cervical can alleviate the condition after conservative treatment, some still need operation. A-SCCC combined with symptomatic cervical radiculopathy or spinal cord high intensity signal spinal cord do not need preventive operation, but still have to observe the change of the disease closely.

【Key words】Cervical vertebra; Spinal cord compression; Radiculopathy; Intervertebral disc degeneration; Clinical protocols

J Spinal Surg, 2015,13(1):20-23

無癥狀頸椎退變性脊髓壓迫(asymptomatic spondylotic cervical cord compression， A-SCCC)是指一類由頸椎退變引起的影像學(xué)表現(xiàn)為頸脊髓壓迫但不伴相應(yīng)癥狀體征的亞臨床型疾病狀態(tài)，其主要臨床癥狀僅有頸部及肩背部的軸性痛[1]，這區(qū)別于同樣由頸椎退變引起的頸脊髓受壓，繼而發(fā)生脊髓損害病理改變，并導(dǎo)致系列臨床表現(xiàn)的脊髓型頸椎病(cervical spondylotic myelopathy，CSM)[2]。A-SCCC與CSM在臨床概念上不相等同，但部分A-SCCC在一定條件下可以加重并出現(xiàn)脊髓損害癥狀及體征，研究發(fā)現(xiàn)影響其轉(zhuǎn)化的高危因素之一是患者出現(xiàn)頸神經(jīng)根病癥狀[2]。……