Katoh S, el Masry W S, Jaffray D, McCall I W, Eisenstein S M, Pringle R G, Pullicino V, Ikata T
Midlands Centre for Spinal Injuries, Oswestry, Shropshire, England.
Spine (Phila Pa 1976). 1996 Oct 15;21(20):2345-51. doi: 10.1097/00007632-199610150-00008.
The neurologic outcomes in patients with conservatively managed incomplete closed traumatic cervical spinal cord injuries was evaluated using the motor scoring system and the Frankel classification.
To show that the motor scoring of recovery system combined with functional Frankel grading will make the documentation of final neurologic outcome more accurate for future comparisons of various methods of treatment.
The influence of surgical and pharmacologic methods of treatment on recovery remains debatable.
Sixty-three consecutive patients with incomplete cervical injuries who were admitted to the hospital within 2 days after injury were included. All patients were treated conservatively with 6 weeks of bedrest and 6 weeks of mobilization with neck support.
Five patients had neurologic deterioration, and all but one patient recovered without surgery. The evaluation of 44 patients who were observed for more than 12 months showed that the preservation of sharp sensation below the level of injury was an indicator of a good prognosis in patients whose injuries were classified as Frankel B, and the degree of recovery of these patients according to the motor score system was comparable with that of patients who were classified as Frankel C. All patients classified as Frankel C who did not deteriorate recovered in Frankel grade. All but one of the patients in the Frankel D group recovered full motor power. The degrees of motor deficit and recovery did not correlate with the mechanism or the degree of the injury of the spinal axis.
Conservative treatment remains a good option for patients with incomplete cervical cord injuries. It is hoped the current study will be a good basis for comparison of the neurologic outcomes of different treatment modalities.
采用运动评分系统和Frankel分级法评估保守治疗的闭合性不完全性创伤性颈脊髓损伤患者的神经功能结局。
表明恢复系统的运动评分与功能性Frankel分级相结合，将使最终神经功能结局的记录更准确，以便未来对各种治疗方法进行比较。
手术和药物治疗方法对恢复的影响仍存在争议。
纳入63例伤后2天内入院的连续性不完全性颈髓损伤患者。所有患者均接受保守治疗，卧床休息6周，佩戴颈部支具活动6周。
5例患者出现神经功能恶化，除1例患者外，其余均未手术而康复。对44例观察超过12个月的患者进行评估，结果显示，损伤平面以下保留刺痛觉是Frankel B级损伤患者预后良好的指标，这些患者根据运动评分系统的恢复程度与Frankel C级患者相当。所有未恶化的Frankel C级患者均恢复至Frankel分级。Frankel D组除1例患者外，其余患者均恢复了全部运动功能。运动功能缺损和恢复程度与脊柱损伤机制或损伤程度无关。
保守治疗仍是不完全性颈髓损伤患者的良好选择。希望本研究能为比较不同治疗方式的神经功能结局提供良好的基础。
