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投稿时间：2024-12-25 网络发布日期：2025-12-25
投稿时间：2024-12-25 网络发布日期：2025-12-25
中文摘要: 目的 比较三种不同手术时机治疗颈髓损伤伴不完全性瘫痪老年患者的临床疗效。方法 回顾性地选取南京医科大学附属淮安第一医院于2019年1月至2023年12月60例60岁以上颈髓损伤伴不完全性瘫痪的老年患者作为研究对象，按手术时间分为A组（伤后3天内手术，n=20）、B组（伤后3～6天手术，n=20）和C组（伤后6天后手术，n=20）。比较三组患者术前、术后5天、术后3个月的日本整形外科学会（JOA）脊髓功能评分、美国脊髓损伤学会（ASIA）评分、神经功能改善率及颈椎功能障碍指数（NDI）。结果 三组患者术前、术后5天和术后3个月的JOA评分、ASIA评分和NDI比较均有显著的时点、组间和交互效应（P<0.05）。从术前、术后5天至3个月，各组患者的JOA评分和ASIA评分逐渐升高，NDI则逐渐下降（P<0.05）。术后3个月B组患者的JOA评分（15.05±1.57）分别高于A组（10.40±2.44）和C组（10.70±1.92）（P<0.05）。术后5天和术后3个月时，B组患者的ASIA评分（77.50±12.32，85.70±9.76）分别高于A组（61.15±12.41，76.00±6.07）和C组（55.70±10.05，70.25±6.67）（P<0.05），神经功能改善率（63.65%±20.82%，78.40%±13.91%）分别高于A组（38.40%±17.80%，60.93%±13.34%）和C组（28.80%±18.85%，53.30%±10.96%）（P<0.05）。术后5天和术后3个月C组患者的NDI（35.60±3.65，28.15±5.15）分别高于A组（31.75±5.16，24.05±6.72）和B组（28.85±6.66，20.20±6.69）（P<0.05）。结论 早期手术治疗老年颈髓损伤伴不完全性瘫痪患者有利于减少脊髓继发性损伤，促进神经功能的恢复，手术时机以伤后3~6天为宜。
Abstract:Objective To compare the clinical efficacy of three different surgical timings in the treatment of cervical spinal cord injury with incomplete paralysis in elderly patients. Methods A retrospective study was conducted on 60 elderly patients (aged over 60) with cervical spinal cord injury and incomplete paralysis who admitted to Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University from January 2019 to December 2023. The patients were divided into three groups based on surgical timing: Group A (surgery within 3 days post-injury, n=20), Group B (surgery between 3-6 days post-injury, n=20), and Group C (surgery after 6 days post-injury, n=20). The Japanese Orthopedic Association (JOA) spinal cord function score, American Spinal Injury Association (ASIA) score, neurological improvement rates, and neck disability index (NDI) were compared among the three groups at preoperative, 5-day postoperative, and 3-month postoperative stages. Results The comparison of JOA score, ASIA score and NDI among the three groups before operation, 5 days and 3 months postoperatively showed significant time effect, between-group effect and interactive effect (P<0.05). According to the order of preoperative and 5 days to 3 months postoperatively, the JOA score and ASIA score of patients in each group increased, while the NDI scores decreased (P<0.05). At 3 months postoperatively, the JOA score of patients in Group B (15.05±1.57) was higher than that in Group A (10.40±2.44) and Group C (10.70±1.92) respectively (P<0.05). At 5 days and 3 months after surgery, the ASIA scores of Group B (77.50±12.32, 85.70±9.76) were higher than those of Group A (61.15±12.41, 76.00±6.07) and Group C (55.70±10.05, 70.25±6.67), respectively (P<0.05), the rates of neurological improvement (63.65%±20.82%, 78.40%±13.91%) were higher these that in Group A (38.40%±17.80%, 60.93% ±13.34%) and Group C (28.80%±18.85%, 53.30%±10.96%) respectively (P<0.05), while the NDI of Group C (35.60±3.65, 28.15± 5.15) were higher than those of Group A (31.75±5.16, 24.05±6.72) and Group B (28.85±6.66, 20.20±6.69), respectively (P<0.05). Conclusion Early surgical treatment of elderly patients with cervical spinal cord injury and incomplete paralysis is beneficial to reduce secondary spinal cord injury and promote the recovery of nerve function, and the appropriate timing of operation is 3-6 days after injury.
keywords: Elderly Cervical spinal cord injury Incomplete paralysis Operation timing Neurological function Recovered after operation
文章编号： 中图分类号：R681.5+4 文献标志码：A
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引用文本：
杨钊琦,戴健,马健,等.颈髓损伤伴不完全性瘫痪老年患者不同手术时机对术后神经功能恢复的影响[J].中国临床研究,2025,38(12):1923-1926.
杨钊琦,戴健,马健,等.颈髓损伤伴不完全性瘫痪老年患者不同手术时机对术后神经功能恢复的影响[J].中国临床研究,2025,38(12):1923-1926.