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 inappropriate 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 Association 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】26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例;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。
Abstract：【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 dislocation. 【Methods】Twenty-six patients with cervical spinal cord injury without fracture and dislocation who received surgery in our department from September 2010 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 underwent spinal decompression surgery. The time of SIADH after injury, serum sodium, urine sodium, plasma osmotic 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 decompression 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 diagnosis and early treatment (sodium intake and fluid infusion restriction) can lead to effective treatment of SIADH.
邱敏;付勤;. 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的疗效观察[J]. 医学临床研究, 2017, 34(4): 707-710.
QIU Min, FU Qin. Study on Preoperative SIADH after Cervical Spinal Cord Injury without Fracture and Dislocation. JOURNAL OF CLINICAL RESEARCH, 2017, 34(4): 707-710.
[1] Takao T,Morishita Y,Okada S,et al.Clinical relationship between cervical spinal canal stenosis and traumatic cervical spinal cord injury without major fracture or dislocation[J].Eur Spine J,2013,22(10):2228-2231. [2] Quigley RS,Akpolat YT,Forrest BD,et al.Reason for lawsuit in spinal cord injury affects final outcome[J].Spine,2015,40(11):851-855. [3] 蔡卫华,张宁,殷国勇,等.急性颈脊髓损伤并发抗利尿激素分泌异常综合征[J].脊柱外科杂志,2008,10(6):271-273. [4] Nakashima H,Yukawa Y,Imagama S,et al.Characterizing the need for tracheostomy placement and decannulation after cervical spinal cord injury[J].Eur Spine J,2013,22(7):1526-1532. [5] Morishita Y,Maeda T,Naito M,et al.The pincers effect on cervical spinal cord in the development of traumatic cervical spinal cord injury without major fracture or dislocation[J].Spinal Cord,2013,51(4):331-333. [6] Kim SY,Shin MJ,Chang JH,et al.Correlation of diffusion tensor imaging and phase-contrast MR with clinical parameters of cervical spinal cord injuries[J].Spinal Cord,2015,53(8):608-614. [7] Samuel AM,Bohl DD,Basques BA,et al.Analysis of delays to surgery for cervical spinal cord injuries[J].Spine,2015,40(13):992-1000. [8] Readdy WJ,Chan AK,Matijakovich DJ,et al.A review and update on the guidelines for the acute non-operative management of cervical spinal cord injury[J].J Neurosurg Sci,2015,59(2):119-128. [9] Hagen EM.Acute complications of spinal cord injuries[J].World J Orthop,2015,6(1):17-23. [10] 王朝阳,梁再跃,陈才平,等.急性颈脊髓损伤继发低钠血症的相关因素分析[J].脊柱外科杂志,2007,5(1):52-54. [11] Ropper AE,Neal MT,Theodore N.Acute management of traumatic cervical spinal cord injury[J].Pract Neurol,2015,15(4):266-272. [12] Lamas C,del Pozo C,Villabona C,et al.Clinical guidelines for management of diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion after pituitary surgery[J].Endocrinol Nutr,2014,61(4):e15-e24. [13] 赵益峰,王仁成,朱凤华,等。颈髓损伤与多尿症、低钠血症[J].中国骨与关节损伤杂志,2005,20(2):142-144. [14] Chen L,Xu M,Zou Y,et al.Clinical analysis of brain trauma-associated SIADH[J].Cell Biochem Biophys,2014,69(3):703-706. [15] Smíd D, Novák P, Fichtl J, et al.Cerebral salt wasting syndrome(CSWS)-rare case from a surgical department[J].Rozhl Chir,2014,93(11):549-553. [16] Runkle I, Villabona C, Navarro A,et al.Treatment of hyponatremia induced by the syndrome of inappropriate antidiuretic hormone secretion:a multidisciplinary Spanish algorithm[J].Nefrologia,2014,34(4):439-450. [17] 刘伟东,吕国华,王冰.急性颈脊髓损伤并发抗利尿激素分泌异常综合征的诊断和治疗[J].中国现代手术学杂志,2006,10(1):52-54. [18] Peri A,Giuliani C.Management of euvolemic hyponatremia attributed to SIADH in hospital setting[J].Minerva Endocrinol,2014,39(1):33-41. (本文编辑:邓丽萍) [收稿日期] 2015-10-30
2017, Vol. 34 
