ANTERIOR DECOMPRESSION AND ARTHRODESIS OF THE CERVICAL-SPINE - LONG-TERM MOTOR IMPROVEMENT .2. IMPROVEMENT IN COMPLETE TRAUMATIC QUADRIPLEGIA

被引:42
作者
ANDERSON, PA
BOHLMAN, HH
机构
[1] VET ADM MED CTR, ACUTE SPINAL CORD INJURY SERV, CLEVELAND, OH 44106 USA
[2] HIGHLAND VIEW HOSP, CLEVELAND, OH USA
[3] UNIV HOSP CLEVELAND, CTR RECONSTRUCT & TRAUMAT SPINE SURG, CLEVELAND, OH 44106 USA
[4] CASE WESTERN RESERVE UNIV, SCH MED, DEPT ORTHOPAED SURG, CLEVELAND, OH 44106 USA
关键词
D O I
10.2106/00004623-199274050-00007
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Fifty-one patients who had complete motor quadriplegia secondary to a fracture or dislocation of the cervical spine were managed by anterior cervical decompression and arthrodesis with iliac bone grafts between 1973 and 1983. In all patients, myelography demonstrated that displaced fragments of bone and disc were compressing the anterior aspect of the spinal cord. Decompression was performed in an attempt to gain further improvement of the motor-roots in the upper extremities and thereby to improve the ability of the patients to care for themselves. The average interval from the injury to the decompression was fifteen months (range, one month to eight years). Two patients died within two months after the operation, one had a respiratory arrest that resulted in brain damage one day after the operation, and two died from cardiovascular disease more than one year after the operation. The remaining forty-six patients were followed for an average of five years (range, two to thirteen years). Neurological improvement of at least two new functional motor-root levels was documented in seven patients and of one level, in eighteen. Increased motor strength by two or three grades was seen in six patients. Noteworthy motor improvement did not occur in the remaining twenty patients. The mean modified Barthel index (used to measure improvement in the ability to perform activities of daily living) increased from 17 to 33 (of a possible 100) points. Functionally important improvement of the caudad part of the cord occurred in only one patient. In one patient, neural injury, with loss of one motor-root level, occurred, with only partial improvement. At the latest follow-up examination, the result was poor in nine of eleven patients who had decompression eighteen months or more after the injury. Only two of these patients had any improvement in the Barthel index, and then of only 5 points each. The result also was poor in the five patients who were more than fifty-three years old; two had no improvement in the Barthel index, one improved by 5 points, and two died.
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页码:683 / 692
页数:10
相关论文
共 36 条
[1]   A MECHANISTIC CLASSIFICATION OF CLOSED, INDIRECT FRACTURES AND DISLOCATIONS OF THE LOWER CERVICAL-SPINE [J].
ALLEN, BL ;
FERGUSON, RL ;
LEHMANN, TR ;
OBRIEN, RP .
SPINE, 1982, 7 (01) :1-27
[2]   STABILIZATION OF THE CERVICAL SPINE BY ANTERIOR FUSION [J].
BAILEY, RW ;
BADGLEY, CE .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1960, 42 (04) :565-594
[4]  
BOHLMAN HH, 1982, EARLY MANAGEMENT ACU, P315
[5]  
BOHLMAN HH, 1981, CLIN ORTHOP RELAT R, V154, P57
[6]  
BOHLMAN HH, 1992, SPINE, V2, P973
[7]  
BOSCH A, 1971, J AMER MED ASSOC, V216, P473
[8]   SOMATOSENSORY EVOKED-POTENTIALS AND NEUROLOGICAL GRADES AS PREDICTORS OF OUTCOME IN ACUTE SPINAL-CORD INJURY [J].
CHEN, L ;
HOULDEN, DA ;
ROWED, DW .
JOURNAL OF NEUROSURGERY, 1990, 72 (04) :600-609
[10]   EVALUATION OF CERVICAL SPINAL-CORD INJURIES WITH METRIZAMIDE MYELOGRAPHY-CT SCANNING [J].
COOPER, PR ;
COHEN, W .
JOURNAL OF NEUROSURGERY, 1984, 61 (02) :281-289