IJPN  >> Vol. 6 No. 4 (November 2017)

    急性颈脊髓损伤手术时机的研究进展
    Advances in Surgical Timing of Acute Cervical Spinal Cord Injury

  • 全文下载: PDF(401KB) HTML   XML   PP.83-89   DOI: 10.12677/IJPN.2017.64013  
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作者:  

宋应豪,孔祥宇,席宇君,曾光亮,李如军,钱志远:苏州大学附属第二医院神经外科,江苏 苏州

关键词:
颈髓损伤早期手术晚期手术预后Cervical Spinal Cord Injury Early Surgical Treatment Late Surgical Treatment Outcome

摘要:

脊柱脊髓损伤是当前危害人类健康的常见病、多发病,其中以颈髓损伤最为多见。急性颈髓损伤是一种很严重的创伤疾病,具有高致残率、致死率的特点。近年来对急性颈脊髓损伤的基础和临床研究已经取得了很大进展,合理的手术时机可以更好得促进脊髓神经功能恢复,但是对于何时手术仍无统一标准,本文现就急性颈髓损伤的救治时机作一综述。

Spinal cord injury is one of the most common and frequent diseases in human health, among which cervical spinal cord injury is the most common. Acute cervical spinal cord injury is a serious trauma disease which has the characteristics of high morbidity and mortality rates. In recent years, great progress has been made in the basic and clinical research of acute cervical spinal cord injury. Reasonable surgical timing can better promote the recovery of spinal nerve function, but there is no uniform standard for when the operation is performed. We review the treatment opportunity of acute cervical spinal cord injury in this paper.

文章引用:
宋应豪, 孔祥宇, 席宇君, 曾光亮, 李如军, 钱志远. 急性颈脊髓损伤手术时机的研究进展[J]. 国际神经精神科学杂志, 2017, 6(4): 83-89. https://doi.org/10.12677/IJPN.2017.64013

参考文献

[1] Chen, Y., He, Y. and DeVivo, M.J. (2016) Changing Demographics and Injury Profile of New Traumatic Spinal Cord Injuries in the United States. Archives of Physical Medicine and Rehabilitation, 97, 1610-1619.
https://doi.org/10.1016/j.apmr.2016.03.017
[2] Yue, J.K., Chan, A.K., Winkler, E.A., et al. (2016) A Review and Update on the Guidelines for the Acute Management of Cervical Spinal Cord Injury-Part II. Journal of Neurosurgical Sciences, 60, 367-384.
https://doi.org/10.1177/230949900701500212
[3] Sapkas, G.S. and Papadakis, S.A. (2007) Neurological Outcome Following Early versus Delayed Lower Cervical Spine Surgery. Journal of Orthopaedic Surgery (Hong Kong), 15, 183-186.
[4] 陈志斌, 陈国锋. 脊髓损伤机制的研究进展[J]. 中外医疗, 2010, 29(33): 184, 186.
[5] Quinzanos-Fresnedo, J. and Sahagun-Olmos, R.C. (2015) Micro RNA and Its Role in the Pathophysiology of Spinal Cord Injury-A Further Step towards Neurodegenerative Medicine. CIR Compagnie Industriali Riunite, 83, 442-447.
[6] Geremia, N.M., Hryciw, T., Bao, F., et al. (2017) The Effectiveness of the Anti-CD11d Treatment is Reduced in Rat Models of Spinal Cord Injury that Produce Significant Levels of Intraspinal Hemorrhage. Experimental Neurology, 295, 125-134.
https://doi.org/10.1016/j.expneurol.2017.06.002
[7] Freria, C.M., Hall, J.C., Wei, P., et al. (2017) Deletion of the Fractalkine Receptor, CX3CR1, Improves Endogenous Repair, Axon Sprouting, and Synaptogenesis after Spinal Cord Injury in Mice. Journal of Neuroscience, 37, 3568- 3587.
https://doi.org/10.1523/JNEUROSCI.2841-16.2017
[8] Fehlings, M.G., Vaccaro, A., Wilson, J.R., et al. (2012) Early versus Delayed Decompression for Traumatic Cervical Spinal Cord Injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One, 7, e32037.
https://doi.org/10.1371/journal.pone.0032037
[9] Ng, W.P., Fehlings, M.G., Cuddy, B., et al. (1999) Surgical Treatment for Acute Spinal Cord Injury Study Pilot Study: Evaluation of Protocol for Decompressive Surgery within 8 Hours of Injury. Neurosurg Focus, 6, e3.
https://doi.org/10.3171/foc.1999.6.1.6
[10] Walters, B.C., Hadley, M.N., Hurlbert, R.J., et al. (2013) Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries: 2013 Update. Neurosurgery, 60, 82-91.
https://doi.org/10.1227/01.neu.0000430319.32247.7f
[11] Van Middendorp, J.J., Hosman, A.J. and Doi, S.A. (2013) The Effects of the Timing of Spinal Surgery after Traumatic Spinal Cord Injury: A Systematic Review and Meta-Analysis. Journal of Neuroscience, 30, 1781-1794.
https://doi.org/10.1089/neu.2013.2932
[12] O'Toole, J.E. (2014) Timing of Surgery after Cervical Spinal Cord Injury. World Neurosurg, 82, e389-e390.
https://doi.org/10.1016/j.wneu.2013.02.024
[13] Dahdaleh, N.S., Lawton, C.D., El, A.T., et al. (2013) Evidence-Based Management of Central Cord Syndrome. Neurosurg Focus, 35, E6.
https://doi.org/10.3171/2013.3.FOCUS13101
[14] Ropper, A.E., Neal, M.T. and Theodore, N. (2015) Acute Management of Traumatic Cervical Spinal Cord Injury. Practical Neurology, 15, 266-272.
https://doi.org/10.1136/practneurol-2015-001094
[15] Carlson, G.D., Gorden, C., Oliff, H.S., et al. (2003) Sustained Spinal Cord Compression: Part I: Time-Dependent Effect on Long-Term Pathophysiology. The Journal of Bone and Joint Surgery, 85, 86-94.
https://doi.org/10.2106/00004623-200301000-00014
[16] Rabinowitz, R.S., Eck, J.C., Harper, C.J., et al. (2008) Urgent Surgical Decompression Compared to Methylprednisolone for the Treatment of Acute Spinal Cord Injury: A Randomized Prospective Study in Beagle Dogs. Spine, 33, 2260-2268.
https://doi.org/10.1097/BRS.0b013e31818786db
[17] Sheng, H., Wang, H., Homi, H.M., et al. (2004) A No-Laminectomy Spinal Cord Compression Injury Model in Mice. Journal of Neurotrauma, 21, 595-603.
https://doi.org/10.1089/089771504774129928
[18] Shields, C.B., Zhang, Y.P., Shields, L.B., et al. (2005) The Therapeutic Window for Spinal Cord Decompression in a Rat Spinal Cord Injury Model. Journal of Neurosurgery: Spine, 3, 302-307.
https://doi.org/10.3171/spi.2005.3.4.0302
[19] Ziu, M., Fletcher, L., Savage, J.G., et al. (2014) Spatial and Temporal Expression Levels of Specific microRNAs in a Spinal Cord Injury Mouse Model and Their Relationship to the Duration of Compression. The Spine Journal, 14, 353-360.
https://doi.org/10.1016/j.spinee.2013.08.015
[20] 杨建东, 李家顺, 贾连顺, 等. 大剂量甲基强的松龙对大鼠急性脊髓损伤预防保护作用的研究[J]. 中国脊柱脊髓杂志, 2005, 15(1): 46-48.
[21] Rouanet, C., Reges, D., Rocha, E., et al. (2017) Traumatic Spinal Cord Injury: Current Concepts and Treatment Update. Arquivos de Neuro-Psiquiatria, 75, 387-393.
https://doi.org/10.1590/0004-282x20170048
[22] 许文胜, 陈永军, 杨增华, 等. 无骨折脱位型颈脊髓损伤手术时机的选择对术后功能恢复的影响[J]. 中国伤残医学, 2016, 24(6): 42-43.
[23] 侯海涛, 孙秀琛, 邵诗泽, 等. 外伤性颈髓损伤手术时机探讨[J]. 骨科, 2011, 2(2): 73-75.
[24] Bracken, M.B., Shepard, M.J., Collins, W.J., et al. (1992) Methylprednisolone or Naloxone Treatment after Acute Spinal Cord Injury: 1-Year Follow-Up Data. Results of the Second National Acute Spinal Cord Injury Study. Journal of Neurosurgery, 76, 23-31.
https://doi.org/10.3171/jns.1992.76.1.0023
[25] Bracken, M.B., Shepard, M.J., Holford, T.R., et al. (1998) Methylprednisolone or Tirilazad Mesylate Administration after Acute Spinal Cord Injury: 1-Year Follow up. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. Journal of Neurosurgery, 89, 699-706.
https://doi.org/10.3171/jns.1998.89.5.0699
[26] Bracken, M.B. (2012) Steroids for Acute Spinal Cord Injury. The Cochrane Database of Systematic Reviews, 1, D1046.
https://doi.org/10.1002/14651858.CD001046.pub2
[27] Teles, A.R., Cabrera, J., Riew, K.D., et al. (2016) Steroid Use for Acute Spinal Cord Injury in Latin America: A Potentially Dangerous Practice Guided by Fear of Lawsuit. World Neurosurgery, 88, 342-349.
https://doi.org/10.1016/j.wneu.2015.12.045
[28] Evaniew, N. and Dvorak, M. (2016) Cochrane in CORR1: Steroids for Acute Spinal Cord Injury (Review). Clinical Orthopaedics and Related Research, 474, 19-24.
https://doi.org/10.1007/s11999-015-4601-6
[29] Evaniew, N., Belley-Cote, E.P., Fallah, N., et al. (2016) Methylprednisolone for the Treatment of Patients with Acute Spinal Cord Injuries: A Systematic Review and Meta-Analysis. Journal of Neurotrauma, 33, 468-481.
https://doi.org/10.1089/neu.2015.4192
[30] Resnick, D.K. (2013) Updated Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injury. Neurosurgery, 72, 1.
https://doi.org/10.1227/NEU.0b013e318276ee7e
[31] Anderson, D.G., Sayadipour, A., Limthongkul, W., et al. (2012) Traumatic Central Cord Syndrome: Neurologic Recovery after Surgical Management. American Journal of Orthopedics, 41, E104-E108.
[32] Chen, L., Yang, H., Yang, T., et al. (2009) Effectiveness of Surgical Treatment for Traumatic Central Cord Syndrome. Journal of Neurosurgery: Spine, 10, 3-8.
https://doi.org/10.3171/2008.9.SPI0822
[33] Liu, Y., Shi, C.G., Wang, X.W., et al. (2015) Timing of Surgical Decompression for Traumatic Cervical Spinal Cord Injury. International Orthopaedics, 39, 2457-2463.
https://doi.org/10.1007/s00264-014-2652-z
[34] McKinley, W., Meade, M.A., Kirshblum, S., et al. (2004) Outcomes of Early Surgical Management versus Late or no Surgical Intervention after Acute Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation, 85, 1818-1825.
https://doi.org/10.1016/j.apmr.2004.04.032
[35] Vaccaro, A.R., Daugherty, R.J., Sheehan, T.P., et al. (1997) Neurologic Outcome of Early versus Late Surgery for Cervical Spinal Cord Injury. Spine, 22, 2609-2613.
https://doi.org/10.1097/00007632-199711150-00006
[36] Marshall, L.F., Knowlton, S., Garfin, S.R., et al. (1987) Deterioration Following Spinal Cord Injury. A Multicenter Study. Journal of Neurosurgery, 66, 400-404.
https://doi.org/10.3171/jns.1987.66.3.0400
[37] Mattiassich, G., Gollwitzer, M., Gaderer, F., et al. (2017) Functional Outcomes in Individuals Undergoing Very Early (< 5 h) and Early (5-24 h) Surgical Decompression in Traumatic Cervical Spinal Cord Injury: Analysis of Neurological Improvement from the Austrian Spinal Cord Injury Study. Journal of Neurotrauma.
https://doi.org/10.1089/neu.2017.5132
[38] Kerwin, A.J., Frykberg, E.R., Schinco, M.A., et al. (2007) The Effect of Early Surgical Treatment of Traumatic Spine Injuries on Patient Mortality. The Journal of Trauma, 63, 1308-1313.
https://doi.org/10.1097/TA.0b013e31815b8361
[39] Boakye, M., Patil, C.G., Santarelli, J., et al. (2008) Laminectomy and Fusion after Spinal Cord Injury: National Inpatient Complications and Outcomes. Journal of Neurotrauma, 25, 173-183.
https://doi.org/10.1089/neu.2007.0395
[40] Croce, M.A., Bee, T.K., Pritchard, E., et al. (2001) Does Optimal Timing for Spine Fracture Fixation Exist? Annals of Surgery, 233, 851-858.
https://doi.org/10.1097/00000658-200106000-00016
[41] Bourassa-Moreau, E., Mac-Thiong, J.M., Ehrmann, F.D., et al. (2013) Complications in Acute Phase Hospitalization of Traumatic Spinal Cord Injury: Does Surgical Timing Matter? Journal of Trauma and Acute Care Surgery, 74, 849-854.
https://doi.org/10.1097/TA.0b013e31827e1381
[42] Jalan, D., Saini, N., Zaidi, M., et al. (2017) Effects of Early Surgical Decompression on Functional and Histological Outcomes after Severe Experimental Thoracic Spinal Cord Injury. Journal of Neurosurgery: Spine, 26, 62-75.
https://doi.org/10.3171/2016.6.SPINE16343
[43] Mac-Thiong, J.M., Feldman, D.E., Thompson, C., et al. (2012) Does Timing of Surgery Affect Hospitalization Costs and Length of Stay for Acute Care Following a Traumatic Spinal Cord Injury? Journal of Neurotrauma, 29, 2816-2822.
https://doi.org/10.1089/neu.2012.2503
[44] 杨建东, 冯新民, 蒋百川, 等. 颈脊髓损伤后外科干预时机的选择[J]. 中国骨与关节损伤杂志, 2010, 25(5): 388-390.
[45] Dvorak, M.F., Noonan, V.K., Fallah, N., et al. (2015) The Influence of Time From Injury to Surgery on Motor Recovery and Length of Hospital Stay in Acute Traumatic Spinal Cord Injury: An Observational Canadian Cohort Study. Journal of Neurotrauma, 32, 645-654.
https://doi.org/10.1089/neu.2014.3632
[46] Umerani, M.S., Abbas, A. and Sharif, S. (2014) Clinical Outcome in Patients with Early versus Delayed Decompression in Cervical Spine Trauma. Asian the Spine Journal, 8, 427-434.
https://doi.org/10.4184/asj.2014.8.4.427
[47] Batchelor, P.E., Kerr, N.F., Gatt, A.M., et al. (2011) Intracanal Pressure in Compressive Spinal Cord Injury: Reduction with Hypothermia. Journal of Neurotrauma, 28, 809-820.
https://doi.org/10.1089/neu.2010.1622
[48] Yang, D.G., Li, J.J., Gu, R., et al. (2013) Optimal Time Window of Myelotomy in Rats with Acute Traumatic Spinal Cord Injury: A Preliminary Study. Spinal Cord, 51, 673-678.
https://doi.org/10.1038/sc.2013.56
[49] Newton, D., England, M., Doll, H., et al. (2011) The Case for Early Treatment of Dislocations of the Cervical Spine with Cord Involvement Sustained Playing Rugby. The Journal of Bone and Joint Surgery. British Volume, 93, 1646-1652.
https://doi.org/10.1302/0301-620X.93B12.27048
[50] Kepler, C.K., Kong, C., Schroeder, G.D., et al. (2015) Early Outcome and Predictors of Early Outcome in Patients Treated Surgically for Central Cord Syndrome. Journal of Neurosurgery: Spine, 23, 490-494.
https://doi.org/10.3171/2015.1.SPINE141013