目的 系统评价手术与保守治疗无骨折脱位型颈脊髓损伤的疗效。方法 应用计算机检索 PubMed、Cochrane Library、EMbase、OVID、CNKI、维普及万方数据库,纳入关于手术及保守治疗无骨折脱位型颈脊髓损伤疗效比较的随机或非随机对照试验。由2名研究人员独立对文献进行筛选、提取和纳入文献评价,采用 Rev-Man 5.3软件对两种治疗的JOA评分、ASIA运动评分、神经功能恢复率、ASIA分级改善进行Meta分析。结果 ①共纳入13 篇研究,共598例患者,手术和保守治疗组分别371例和227例;②Meta分析显示,与保守治疗相比,手术治疗后的JOA评分更高[MD=3.08,95%CI(2.71,3.45),Z=16.29,P<0.000 01];神经功能恢复率更高[MD=15.87,95%CI(9.28,22.46),Z=4.72,P<0.000 01];ASIA分级改善更明显[OR=2.3,95%CI(1.25,4.15),Z=2.76,P=0.006];在ASIA运动评分方面,两者无差异[MD=5.45,95%CI(-7.56,18.47),Z=0.82,P=0.41]。结论 对于无骨折脱位型颈脊髓损伤的患者,手术治疗更有利于患者神经功能的改善。

Objective To systematically assess the clinical efficacy of surgical treatment versus conservative treatment for CSCIWFD from previously clinical investigations. Methods A systematic search of all the studies published was conducted on the PubMed, Cochrane Library, EMbase, OVID, CNKI, VIP and Wanfang databases. Randomized and non-randomized controlled trials that compared between surgical treatment and conservative treatment for CSCIWFD were identified. Two reviewers independently screened the literature according to the inclusive and exclusive criteria, extracted the data, and assessed the quality of included studies. Meta-analyses were performed to assess variables including Japanese Orthopaedic Association scores(JOA), Neurological function recovery rate, ASIA impairment scale grade, ASIA motor scores. Results ①A total of 13 articles were included, involving 598 patients, of which 371 and 227 patients received sugical or conservative treatment. ②The results of the meta-analysis indicated that, compared with conservative group, surgical group has higher JOA scores[MD=3.08,95%CI(2.71,3.45),Z=16.29,P<0.000 01], better Neurological function recovery rate[MD=15.87,95%CI(9.28,22.46),Z=4.72,P<0.000 01], better ASIA impairment scale grade improvement[OR=2.3,95%CI(1.25,4.15),Z=2.76,P=0.006], and there were no significant differences in the ASIA motor scores[MD=5.45,95%CI(-7.56,18.47),Z=0.82,P=0.41]. Conclusion These result suggests that surgical treatment can improve the neurological function more effectively for patients with cervical spinal cord injury without fracture and dislocation.

目的 探讨内科治疗的高血压基底节区出血的疗效及预后相关的因素。方法 回顾性分析2005年4月—2014年12月贵阳市第二人民医院神经外科收治的174例高血压脑出血患者的临床资料,所有患者均采用内科保守治疗,对疗效及影响患者预后的因素进行分析。结果 174例患者中,死亡50例,持续植物生存状态4例,对124例存活患者进行随访,随访时间2~117个月,随访ADL分级Ⅰ级43例,Ⅱ级53例,Ⅲ级21例,Ⅳ级3例,Ⅴ级4例,预后较好者(ADL分级Ⅰ~Ⅱ级)96例,预后不良者(ADL分级Ⅲ~Ⅴ级)28例。χ²检验显示入院 GCS评分和出血量是影响患者预后的因素。结论 影响高血压基底节区脑出血患者的预后因素较多,GCS评分较高、出血量少的患者可采用内科治疗,多数患者预后较好。

Objective To investigate treatment efficacy and the factors influencing prognosis of conservative treatment of hypertensive intracerebral hemorrhage in basal ganglia. Methods A retrospective analysis was conducted on the clinical data of 174 patients with hypertensive intracerebral hemorrhage in basal ganglia who were admitted to our hospital during the period from April 2005 to December 2014. All the patients were given internal medicine conservative treatment and followed up to observe the clinical curative effect to analyze the prognosis. Results Of the 174 patients, 50 patients died and 4 patients were persistent vegetative state. 124 patients were followed up for 2-117 months and they were classified according to ability of daily life(ADL) prognosis scale: 43 cases were in I grade, 53 cases in II grade, 21 cases in III grade, 3 cases in IV grade, 4 cases in V grade. 96 cases achieved favourable outcomes and 28 cases got poor outcomes.The results of Chi square test revealed that GCS scale and intracerebral hemorrhage volume were the factors influencing prognostic of hypertensive intracerebral hemorrhage in basal ganglia. Conclusion There were many prognosis factors related with hypertensive intracerebral hemorrhage. The curative effect and prognosis in patients with conservative treatment is obvious in these patients with high GCS scale and less intracerebral hemorrhage volume.