Tan Jian, Hu Fanchen, Ou Jun, Su Xiaotao, Liu Jingnan
The Affiliated Nanhua Hospital, Department of Spinal Surgery, Hengyang Medical School, University of South China, Hengyang, Hunan 421000, China.
Evid Based Complement Alternat Med. 2022 Aug 8;2022:6836966. doi: 10.1155/2022/6836966. eCollection 2022.
The study aimed to investigate the effect of anterior cervical surgery in the treatment of spinal cord injury without radiographic abnormalities (SCIWORAs) and analyze the related factors affecting the prognosis of patients.
A total of 86 patients with SCIWORA who were admitted to our hospital from June 2018 to March 2021 were selected as the research subjects. According to the different treatment methods selected by the patients, they were divided into the control group ( = 38) and the observation group ( = 48). The control group was treated with conservative therapy, and the observation group was treated with anterior cervical total laminectomy decompression, internal fixation, and bone graft fusion. The efficacy of the treatment was assessed preoperatively and 6 months after surgery using the Japanese Orthopedics Association (JOA) functional evaluation criteria for cervical spinal cord injury. The improvement rate of the JOA score at the last follow-up visit was calculated according to the Hirabayashi formula to evaluate the prognosis of patients.
The JOA score of the observation group six months after surgery was (14.98 ± 2.75) that was higher than that of the control group (12.16 ± 2.54) ( < 0.05). After surgery, the improvement rate of the JOA score in the observation group was higher than that in the control group ( < 0.05). After surgery, the scores of health condition, physiological function, and role physical in the observation group were (23.18 ± 1.09), (22.75 ± 1.54), and (22.64 ± 1.46), which were higher than those in the control groups (20.94 ± 1.65), (20.26 ± 1.78), and (19.56 ± 1.82) ( < 0.05). The results of univariate analysis showed that the ASIA classification of cervical spinal cord injury, the type of MRI cervical spinal cord injury, the scope of cervical spinal cord injury, lumbar disc herniation, and the time from injury to treatment were all related to the prognosis of the patients ( < 0.05). Multivariate analysis showed that the ASIA classification of cervical spinal cord injury, the type of MRI cervical spinal cord injury, the scope of cervical spinal cord injury, and the time from injury to treatment were the independent factors affecting the prognosis of patients ( < 0.05).
For patients with SCIWORA, anterior total lamina decompression and internal fixation with bone grafting and fusion can effectively promote the recovery of cervical spinal cord function and improve the prognosis and quality of life of patients. The ASIA classification of cervical spinal cord injury, the type of MRI cervical spinal cord injury, the scope of cervical spinal cord injury, and the time from injury to treatment were the independent prognostic factors for patients.
本研究旨在探讨颈椎前路手术治疗无放射学异常的脊髓损伤（SCIWORA）的效果，并分析影响患者预后的相关因素。
选取2018年6月至2021年3月我院收治的86例SCIWORA患者作为研究对象。根据患者选择的不同治疗方法，将其分为对照组（n = 38）和观察组（n = 48）。对照组采用保守治疗，观察组采用颈椎前路全椎板减压、内固定及植骨融合术。术前及术后6个月采用日本骨科学会（JOA）颈椎脊髓损伤功能评价标准评估治疗效果。根据平林公式计算末次随访时JOA评分的改善率，以评估患者的预后。
观察组术后6个月JOA评分为（14.98 ± 2.75），高于对照组（12.16 ± 2.54）（P < 0.05）。术后观察组JOA评分改善率高于对照组（P < 0.05）。术后观察组健康状况、生理功能和身体角色评分分别为（23.18 ± 1.09）、（22.75 ± 1.54）和（22.64 ± 1.46），高于对照组的（20.94 ± 1.65）、（20.26 ± 1.78）和（19.56 ± 1.82）（P < 0.05）。单因素分析结果显示，颈椎脊髓损伤的ASIA分级、MRI颈椎脊髓损伤类型、颈椎脊髓损伤范围、腰椎间盘突出症及受伤至治疗时间均与患者预后相关（P < 0.05）。多因素分析显示，颈椎脊髓损伤的ASIA分级、MRI颈椎脊髓损伤类型、颈椎脊髓损伤范围及受伤至治疗时间是影响患者预后的独立因素（P < 0.05）。
对于SCIWORA患者，前路全椎板减压、内固定并植骨融合可有效促进颈椎脊髓功能恢复，改善患者预后及生活质量。颈椎脊髓损伤的ASIA分级、MRI颈椎脊髓损伤类型、颈椎脊髓损伤范围及受伤至治疗时间是患者的独立预后因素。
