摘要目的 探讨高压氧(hyperbaric oxygen,HBO)治疗小儿先天性脊柱侧弯(congenital scoliosis,CS)矫形手术并发医源性脊髓损伤(iatrogenic spinal cord injury,ISCI)的临床疗效.方法 回顾分析我院2010年1 1月-2014年9月收治的8例CS矫形手术并发ISCI患儿的年龄、性别、术后开始HBO治疗的时间、HBO治疗的次数、HBO治疗前后的大小便功能、下肢肌力、ASIA评级,以及远期预后.结果 8例CS患儿,矫形术前脊髓功能均正常,择期接受了侧弯矫形手术治疗,术后出现严重的脊髓损伤(spinal cord injury,SCI)表现:大小便功能部分或完全障碍(1例未受损),下肢肌力0～3级,美国脊髓损伤协会(American Spinal Injury Association,ASIA)分级标准评定B～C级.分别在术后第3～7天(平均第5天)开始HBO治疗;HBO治疗次数为7～ 50次,平均25次.HBO治疗结束时,患儿大小便功能均恢复正常,下肢肌力恢复至3～5级,ASIA评定C～E级,平均提高3级.随访平均17.6个月,最长37个月,7例脊髓功能正常,恢复上学(园),1例失访.结论 对于小儿CS矫形手术造成的ISCI,早期联合HBO治疗可能是有效的手段.

abstractsObjective To explore the effect of hyperbaric oxygen (HBO) on iatrogenic spinal cord injury (ISCI) associated with spinal corrective surgery in child congenital scoliosis (CS).Methods The subjects of our study were 8 cases of ISCI associated with corrective surgery for CS admitted into our hospital for treatment from November 2010 to September 2014.Age,gender,the starting time of HBO therapy after surgery,sessions of HBO therapy,micturition and defecation,muscle strength of lower extremities and ASIA scores (grade) before/after HBO therapy,and long-term prognosis were analyzed retrospectively.Results The spinal cord function of 8 congenital scoliosis child patients displayed normal before surgery,and they received corrective surgical treatment at proper time.Serious symptoms of SCI were displayed after surgery:partial or complete disorder of micturition and defecation (only one case was normal);muscle strength of the lower extremities was 0-3;ASIA scores were of B-C grades.After surgery,the patients respectively received HBO therapy for 3 to 7 days,averaging 5 days,with total treatment sessions of 7 to 50,averaging 25 sessions.Upon completion of HBO therapy,all the child patients had normal micturition and defecation (except 1 case),muscle strength of lower extremities recovered to 3-5 grades,and ASIA evaluation was of C-E grades,increasing by 3 grades on the average.The mean follow-up time was 17.6 months,with the longest follow-up time being 37 months.Neurologic functions of spinal cord in seven patients all recovered,they either went to school or kindergarten.One case failed to have medical follow-up.Conclusions Surgery coupled with early HBO therapy might be an effective treatment method for ISCI associated with spinal corrective surgery for CS.