The Clinical Studies Of Surgical And Non-surgical In The Treatment Of Adult Cervical Cord Injury Without Fracture And Dislocation

Cervical cord injury without fracture and dislocation which is unified the name of cervical spinal cord injury without radiographic abnormality(CSCIWORA) is a kind of special type of spinal cord injury. It is a kind of clinical common diseases accounting for 37%- 52% in the cervical spinal injury especially in the neck injuries after the use of inspection methods such as X-ray, CT that cervical vertebra is not found obvious fracture or dislocation.This disease frequently occurs in two groups: children and the adults whose cervical vertebra always exist pathological changes formerly. Children probably occur transient cervical spinal pull or dislocation and then quick recover by the reason of the good elasticity of muscle, ligament and joint capsule which is beside the cervical vertebral. The adult with pathological cervical vertebra changes may easily cause cervical spinal injury by slight external force because of the cervical stenosis which decrease the space of vertebral canal and the bulging or herniation of intervertebral disc and ossification of posterior longitudinal ligament, specially in the excessive stretch and buckling of cervical vertebra which cause the sagittal diameter of vertebral canal more narrow and the aggravated herniated nucleus pulposus or the creases of yellow ligament herniating into spinal canal, which can cause compression of the spinal cord and produce clinical symptoms. The characteristic symptoms of CSCIWORA is secretiveness and hysteresis, and the X-ray, CT has no positive performance, so it has high missed diagnosis. The cervical spinal injury can only be found by MRI. It is need relatively high technique to the clinician’s, if it is not be timely diagnosised or treatment. That will lead to serious consequences. There is no thorough research of the CSCIWORA in pathogenesis.Most people’ thought is the many factors which caused the consequence. The direct factors of injury is falling and accident. Their common ground is the external force which act on head and neck is ont very serious. At present most scholars owen different views on the treatment of CSCIWORA. It is lack of theoretical basis. So the aim of this paper is to provide certain theoretical basis by using relevant scoring criteria and statistical methods, and then give help for the treatment of CSCIWORA in clinic.Objective: At present to CSCIWORA, the treatment of surgery or non-surgery is a disputes all the time. In order to obtain theoretical basis of surgical treatment, this study aims is to compare the result curative effect score of the surgical and non-surgical patients with CSCIWORA when they are on admission, discharge, three months and six months after discharge by stages, and then to obtain effective treatment methods of the CSCIWORA.Methods: 30 patients with CSCIWORA are selected from the trauma emergency area of the No. 3 hospital hebei medical university units in August 2013 to October 2014, of which have 24 cases of men, 6 women, and the range of age is form 26 to 66 years, the average age is 48.1 years. 10 cases were followe-up by outpatient service and 20 cases were follow-up by telephone, except 2 cases were lost to follow-up and 2cases were dead, the other 26 patients were effective followed-up.Follow-up period sustained for 20 months. These 26 cases are divided into two groups.A group of 13 cases were gave surgery, B group of 13 cases were not gave surgery which are performed by the chief physician of our department within seven days. Use the standard of Japanese orthopaedic association(JOA) score system to all cases when they are admission, discharge, three months, six months later to give a mark and the range of mark,and then process the results of statistics by using the two independent sample test. Use the neural classification standard of international spinal cord injury score at the time of admission and discharge six months follow-up to evaluate the function by using the Kruskal-Wallis and then analyze the results.Results:Using the software of SPSS(13.0) analysis the results. Measurement data was with `X±S said. admission P<0.1, discharge P<0.05, 3month P<0.05, 6month P<0.05(significant differences). Using the two independent sample test to compare the JOA score rises Of group A and B at the time of admission and discharge, three months, six months(P<0.05, significant differences). Use neural classification standard of international spinal cord injury association(ASIA) to evaluate the recovery of neurological function in hierarchies at the time of discharge and six months follow-up, and analysis the result by using Mann-Whitney U rank and inspection,(P<0.05 statistical significance). In all the medical records, there are two panplegia patients at the time of admitting to hospital whose recovery of spinal cord functional is poor, the rest of the patients had different recovery of degrees. ASIA classification: Group A: pre-operation: A 1 case, B 3cases, C 8cases, D 1 case, E 0 case; postoperation: A 0 case, B 1 case,C 2 cases,D 8 cases, E 2 cases.Group B pre-operation:A 1 case, B 2 cases, C 7 cases, D 3cases, E 0 cases; postoperation: A 1 case, B 1 case, C 7 cases, D 4 cases, E 0 case.Conclusion: For patients with CSCIWORA, active surgery treatment can provide conditions for the recovery of the spinal cord function. The curative effect of non-surgical treatment patients with CSCIWORA is not obvious. Operation can remove pressure the and stabilize the cervical spine, and it is very favorable for spinal cord functional recovery in future.