摘要
【目的】探讨手术治疗无骨折脱位颈脊髓损伤合并抗利尿激素分泌失调综合征（syndrome of inap-propriate secretion of antidiuretic hormone，SIADH）的疗效。【方法】回顾性分析2010年9月至2014年9月本院骨科诊治的26例无骨折脱位颈脊髓损伤患者，术前患者Frankel分级：A级12例，B级及以下14例。所有患者均接受椎管减压手术治疗，采用Franke脊髓损伤分级及日本骨科协会评分（Japanese Orthopaedic As-sociation Scores，JOA）评估脊髓损伤程度，并观察伤后并发SIADH的时间及疗效。【结果126例患者均获得随访，随访时间26（12～37）个月，末次随访时Frankel分级：A级8例，B级及以下18侧；末次随访时JOA评分为（11．6±3．1）分，JOA评分改善率为78．2％。患者出现SIADH的时间为伤后（4～10）d，恢复时间为（28．4±13．8）d。【结论】手术治疗无骨折脱位颈脊髓损伤患者安全可靠，但围手术期并发的SIADH应重视，补钠并控制入液量能有效地治疗SIADH。
[Objective]To investigate the outcomes of surgery in patients＂ treatments who have syndrome of inappropriate secretion of antidiuretic （SIADH） after cervical spinal cord injury without fracture and disloca- tion. [Methods]Twenty-six patients with cervical spinal cord injury without fracture and dislocation who re- ceived surgery in our department from September 2,010 to September 2014 were retrospectively analyzed. Frankel classification and Japanese Orthopedic Association （JOA） scores were recorded to estimate the level of spinal cord injury. Before surgery, Frankel grade A had 12 cases and grade B had 14 cases. All patients under- went spinal decompression surgery. The time of SIADH after injury, serum sodium, urine sodium, plasma os- motic pressure, urine osmotic pressure and final result were summarized and analyzed. [Results] All twenty- six patient were followed up between twelve and thirty-seven months, average twenty-six months. In the last follow-up, eight cases belonged to Frankel classification grade A and eighteen cases belonged to grade B （or below B）. JOA score was 11.6±3.1 in the last follow-up and the rate of improvement was 78.2%. The time of SIADH was 4-10 days after injury and time of recovery was 28.4 ± 13.8 days. [Conclusion] The spinal de- compression surgery was safe and reliable for the patients with cervical spinal cord injury without fracture and dislocation, however, special attention should be paid to SIADH during the perioperative period. Early diagno- sis and early treatment （sodium intake and fluid infusion restriction） can lead to effective treatment of SIADH.
出处
《医学临床研究》
CAS
2017年第4期707-710,共4页
Journal of Clinical Research
