| 下颈椎损伤改良Moore分类的临床应用研究 |
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Received:September 25, 2010
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| 作者 | Author | 单位 | Unit | E-Mail |
| 骆剑敏 |
LUO Jian-min |
绍兴市人民医院骨科，浙江 绍兴 312000 |
Department of Orthopaedics, People's Hospital of Shaoxing, Shaoxing 312000, Zhejiang, China |
ljmsx@sina.com |
| 李宏斌 |
LI Hong-bin |
绍兴市人民医院骨科，浙江 绍兴 312000 |
Department of Orthopaedics, People's Hospital of Shaoxing, Shaoxing 312000, Zhejiang, China |
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| 钱宇 |
QIAN Yu |
绍兴市人民医院骨科，浙江 绍兴 312000 |
Department of Orthopaedics, People's Hospital of Shaoxing, Shaoxing 312000, Zhejiang, China |
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| 金以军 |
JIN Yi-jun |
绍兴市人民医院骨科，浙江 绍兴 312000 |
Department of Orthopaedics, People's Hospital of Shaoxing, Shaoxing 312000, Zhejiang, China |
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| 张军 |
ZHANG Jun |
绍兴市人民医院骨科，浙江 绍兴 312000 |
Department of Orthopaedics, People's Hospital of Shaoxing, Shaoxing 312000, Zhejiang, China |
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| 陈雪荣 |
CHEN Xue-rong |
绍兴市人民医院骨科，浙江 绍兴 312000 |
Department of Orthopaedics, People's Hospital of Shaoxing, Shaoxing 312000, Zhejiang, China |
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| 曾青东 |
ZENG Qing-dong |
绍兴市人民医院骨科，浙江 绍兴 312000 |
Department of Orthopaedics, People's Hospital of Shaoxing, Shaoxing 312000, Zhejiang, China |
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| 期刊信息：《中国骨伤》2011年24卷，第5期，第382-386页 |
| DOI：10.3969/j.issn.1003-0034.2011.05.007 |
| 基金项目:浙江省绍兴市科技局资助项目(编号：2008A33002) |
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目的：探讨改良Moore分类法在下颈椎损伤中的临床应用。
方法：2006年8月至2010年3月收治下颈椎损伤患者200例，男165例，女35例；年龄19～88岁，平均52岁。应用下颈椎损伤改良Moore分类全面地描述下颈椎损伤的状态，颈椎损伤严重程度(稳定性)量化评分与有否神经症状表现相结合，根据骨折类型和稳定性、脊髓或神经根受压损伤情况、韧带损伤后的稳定程度及其他参考因素进行分类诊治，选择治疗方法。其中伴有脊髓神经损伤者130例(ASIA评分：A级6例，B级13例，C级43例，D级68例),不伴有脊髓神经损伤者70例。对伴有脊髓神经损伤的下颈椎损伤患者，根据ASIA评分进行疗效评定；对不伴有脊髓神经损伤的患者，根据影像学检查对颈椎的序列和高度进行观察。
结果：前、左、右侧和后柱均损伤35例；前柱损伤33例；前、后柱均损伤90例；前、左侧和后柱均损伤5例；前、右侧和后柱均损伤3例；前、左侧和右侧柱均损伤3例；前、右侧柱损伤2例；前、左侧柱损伤5例；后柱损伤12例；左侧柱损伤7例；右侧柱损伤5例。200例患者中手术治疗98例，非手术治疗102例(其中可以手术而患者家属要求非手术治疗39例).完全性脊髓损伤患者中3例行手术后脊髓功能无恢复迹象，ASIA分级无变化，但其肢体麻木、疼痛等症状有不同程度的缓解，另3例未手术患者脊髓功能及肢体症状均无变化。不完全性脊髓损伤患者手术后脊髓功能均有一定程度恢复，ASIA评分平均提高1.2级。未手术的不完全性脊髓损伤患者非手术治疗后ASIA评分平均提高0.3级。不伴有脊髓神经损伤者手术后经影像学检查显示均恢复了颈椎的正常序列和高度。
结论：根据改良Moore分类法，稳定性量化评分值大于等于4分有下颈椎不稳可能，需要手术治疗，分值越大，手术指征越明显，若伴有脊髓或神经根受压损伤表现者则有绝对手术指征。稳定性量化评分为3分且伴有脊髓或神经根受压损伤表现者一般也有手术指征。稳定性量化评分为3分不伴有脊髓或神经根受压损伤表现者或3分以下者均不需要手术治疗。应用改良Moore分类法有利于下颈椎损伤患者的临床规范化、标准化诊治，以获得较满意的疗效。 |
| [关键词]:颈椎 脊髓损伤 关节不稳定性 分类法 |
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| Clinical application study of modified Moore classification in lower cervical spine injuries |
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Abstract:
Objective: To analyze the clinical application of modified Moore classification in lower cervical spine injuries.
Methods: Modified Moore classification was applied in the morphologic description of 200 patients (including 165 males,35 females,age ranging from 19 to 88 years,with an average age of 52 years) with lower cervical spine injuries from August 2006 to March 2010,cervical spine injury severity score (quantification of stability) in combination with yes/no neurological injury status to classify their clinical diagnosis and management. The treatment was selected according to the fracture type,stability,compression injury of spinal cord or nerve roots,stability of ligamentous injury and other reference factors. According to the ASIA score,130 cases with injury of spinal cord or nerve root (i.e. 6 cases in Grade A,13 cases in Grade B,43 cases in Grade C,68 cases in Grade D);and 70 cases with no injury of spinal cord or nerve root. The ASIA score was applied in the evaluation of curative effect in cases with injury of spinal cord or nerve root. Radiodiagnostics was used to observe sequential measurement of cervical vertebrae and height in cases without spinal cord or nerve root injuries.
Results: The cervical spine injury distribution is that 35 cases of anterior,left,right lateral and posterior column injury;33 cases of anterior column injury;90 cases of anterior and posterior column injury;5 cases of anterior,left lateral and posterior column injury;3 cases of anterior,right lateral and posterior column injuries;3 cases of anterior,left and right lateral column injuries;2 cases of anterior and right lateral column injuries;5 cases of anterior and left lateral column injury;12 cases of posterior column injury;7 cases of left lateral column injury;5 cases of right lateral column injury. Surgery operation was given in 98 patients out of 200 cases. Non-surgical treatment was given to 102 patients (including 39 patients who are qualified to receive operation,but patient's relative required non-surgical treatment). Three cases of complete injury of spinal cord showed no recovery of the spinal cord function after operation,no change on the ASIA score,but pain and numbness of limb relieved slightly. Three non-surgical treatment cases showed no change after the treatment. Cases of incomplete injury of spinal cord showed certain recovery on spinal cord function after operation,and the ASIA score was raised 1.2 grades averagely. The ASIA score of cases of incomplete injury of spinal cord after non-surgical treatment was raised 0.3 grades averagely. The alignment and height of cervical vertebras were normal on post-operative radiodiagnostics in patients without injury of spinal cord or nerve root.
Conclusion: According to modified Moore classification,when the stability quantification score is higher than or equal to 4,it indicated that the cervical vertebras are instability in lower cervical spine injuries. Surgery operation is required in higher score and less stability cases. Cases associated with neurological injury must receive surgery operation. Cases with stability quantification score equals to 3 and neurological injury should also receive surgery operation in general. Surgery operation is not required in cases of stability quantification equal to 3 and without neurological injury,or cases of stability quantification score lower than 3. Applying modified Moore classification in the treatment of lower cervical spine injuries is beneficial for the clinical standardization,diagnosis and treatment and receives satisfactory therapeutic effects. |
| KEYWORDS:Cervical vertebrea Spinal cord injuries Joint instability Classification |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 骆剑敏,李宏斌,钱宇,金以军,张军,陈雪荣,曾青东.下颈椎损伤改良Moore分类的临床应用研究[J].中国骨伤,2011,24(5):382~386 |
| 英文格式: | LUO Jian-min,LI Hong-bin,QIAN Yu,JIN Yi-jun,ZHANG Jun,CHEN Xue-rong,ZENG Qing-dong.Clinical application study of modified Moore classification in lower cervical spine injuries[J].zhongguo gu shang / China J Orthop Trauma ,2011,24(5):382~386 |
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