非创伤性脊髓损伤的临床特点

摘要

Objective To investigate the clinical characteristics of nontraumatic spinal cord injury, including the demographic character-istics, etiology and neurological function. Methods 44 patients with nontraumatic spinal cord injury in the past 4 years were reviewed. Re-sults There were 27 males (61.3%) and 17 females (38.7%) with mean age of 39.85 years (3.5~78). They were followed up for mean of 13.3 (3~23) months. Myelitis (36%) and spinal tumor (including primary and metastatic tumor, 18.1%) were the most common causes, followed by intraspinal tumor (15.9%), vascular disease (13.6%), nontraumatic acute disc herination (6.8%), spinal cord ischemia after non-spinal sur-gery (4.5%) and hepatic myelopathy (4.5%). Neurological function at the initial admission included tetraplegia in 9 patients, paraplegia in 30 patients, conus medullaris syndrome in 2 patients and cauda equina syndrome in 2 patients. Neurological function of ASIA at the initial admission included A in 14 cases, B in 6, C in 13 and D in 11. 34%patients improved at least one ASIA grade when evaluated at final follow up. Conclusion Nontraumatic etiologies contribute to a significant proportion for spinal cord injury. Patients with nontraumatic spinal cord injury present the clinical characteristics different from traumatic spinal cord injury cases.%目的：探讨非创伤性脊髓损伤患者的人口学特征、病因学分布以及神经功能预后。方法对44例非创伤性因素造成的脊髓损伤患者的临床资料进行回顾性分析。结果患者均获得3个月以上随访，平均随访时间13.3个月(3~23个月)。其中男性27例(61.3%)，女性17例(38.7%)；平均年龄39.85岁(3.5~78岁)。病因包括脊髓炎16例(36%)，脊柱肿瘤8例(18.1%)，椎管内肿瘤7例(15.9%)，脊髓血管畸形6例(13.6%)，非创伤性椎间盘突出3例(6.8%，包括颈椎间盘突出致四肢瘫1例，腰椎间盘突出致马尾综合征2例)，非脊柱手术造成的医源性脊髓缺血2例(4.5%)，肝性脊髓病2例(4.5%)。入院时神经损伤情况：颈段脊髓损伤9例(20.4%)，胸段损伤30例(68.1%)，圆锥综合征2例(4.5%)，马尾综合征3例(6.8%)。AISA残损分级：A级14例(31.8%)，B级6例(13.6%)，C级13例(29.5%)，D级11例(25%)。最终随访时，34%患者出现至少1个等级的神经功能恢复。结论非创伤性脊髓损伤是造成脊髓损伤的重要原因。因具有特殊的病因学特点，此组病例在人口学特征以及临床特点上与创伤性脊髓损伤患者有较大区别。