單節(jié)段頸前路椎間盤切除減壓固定植骨融合術(shù)椎間隙高度恢復(fù)程度對臨床療效的影響
發(fā)布時間：2018-11-13 17:30
【摘要】：目的:對ACDF(頸椎前路椎間盤切除減壓內(nèi)固定植骨融合術(shù))這一手術(shù)方式治療單節(jié)段頸椎退變性疾病(Cervical degenerative disc disease,CDDD)過程中,椎間隙高度恢復(fù)程度對臨床療效的影響進行探討,從而為術(shù)者在行頸前路手術(shù)中選擇合適的椎間隙撐開高度提供參考和評價。方法:回顧性分析了從2012年1月至2014年12月于大連醫(yī)科大學(xué)附屬第一醫(yī)院的150例行因CDDD行單節(jié)段ACDF的患者,男性和女性分別為95例、55例,病人年齡范圍為51歲～83歲,年齡的平均值為(65.39±9.59)歲。累及部位:C3/4 9例C4/5 30例C5/6 96例C6/7 15例。根據(jù)手術(shù)中椎間隙高度恢復(fù)程度占基準(zhǔn)高度的百分率分為A組(術(shù)后即刻椎間高度/目標(biāo)椎間隙基準(zhǔn)高度位于100-120%)28例;B組(術(shù)后即刻椎間高度/目標(biāo)椎間隙基準(zhǔn)高度位于120-140%)63例;C組(術(shù)后即刻椎間高度/目標(biāo)椎間隙基準(zhǔn)高度位于140-160%)59例。經(jīng)比較:不同組別病人一般信息、手術(shù)部位分布無顯著差異,可比性較好。通過對不同分組手術(shù)前后及末次隨訪等不同時期神經(jīng)功能緩解情況、頸椎軸性癥狀發(fā)生率、目標(biāo)椎間隙高度變化、相鄰節(jié)段退變情況等指標(biāo)的比較,分析不同椎間隙高度恢復(fù)程度對臨床療效的影響。結(jié)果:1.三組患者年齡、性別經(jīng)兩兩組間獨立樣本檢驗分析,P0.05,無統(tǒng)計學(xué)意義,即三組患者的年齡分布無差別,說明三組具有可比性。2.三組術(shù)前J0A分析結(jié)果顯示三組無統(tǒng)計學(xué)差異,F=924,p=0.399,大于0.05。術(shù)后三組的J0A評分均有明顯的提高,均較術(shù)前差異有統(tǒng)計學(xué)意義。神經(jīng)功能恢復(fù)率:B組71.88%優(yōu)于C組68.62%優(yōu)于A組42.25%,120-140%椎間隙高度神經(jīng)恢復(fù)率最佳。3.頸椎軸性癥狀三組患者頸前路融合術(shù)后2年,頸椎軸性癥狀的發(fā)生率分別為35.71%、15.87%和42.37%。三組患者的術(shù)后2年軸性癥狀發(fā)病率A組和C組的發(fā)生率均高于B組,均存在統(tǒng)計學(xué)差異。B組120-140%椎間隙高度是最理想選擇。4.術(shù)后即刻椎間隙高度,B組C組恢復(fù)高度大于A組,而B組C組之間無統(tǒng)計學(xué)差異。至末次隨訪椎間隙高度丟失,C組高度丟失最大,與A組B組有統(tǒng)計學(xué)差異。5.在平均2年隨訪時,相鄰椎間隙丟失高度量,B組丟失量最小,分別比較A組、C組,P小于0.05,均存在統(tǒng)計學(xué)差異。A組、C組比較無統(tǒng)計學(xué)差異。結(jié)論:本課題通過臨床回顧性研究發(fā)現(xiàn),椎間隙恢復(fù)高度達(dá)基準(zhǔn)高度100-160%時,2年隨訪期內(nèi)均未出現(xiàn)脊髓過度牽拉等嚴(yán)重并發(fā)癥,均較術(shù)前取得良好療效。其中以120-160%基準(zhǔn)高度為較理想高度,J0A神經(jīng)功能取得更好的恢復(fù)。又考慮術(shù)后頸椎軸性癥狀、隨訪目標(biāo)椎間隙高度丟失、相鄰椎間隙高度丟失,以120-140%基準(zhǔn)高度最佳,推薦ACDF椎間隙恢復(fù)高度達(dá)到基準(zhǔn)高度120-140%。
[Abstract]:Objective: to treat single segment cervical degenerative disease (Cervical degenerative disc disease,CDDD) with ACDF (anterior cervical disc resection, decompression, internal fixation and fusion). The effect of the recovery degree of intervertebral space height on clinical curative effect was discussed, so as to provide a reference and evaluation for the choice of appropriate intervertebral space open height in anterior cervical surgery. Methods: from January 2012 to December 2014, one hundred and fifty patients (95 male and 55 female) with single segment ACDF received CDDD in the first affiliated Hospital of Dalian Medical University were analyzed retrospectively. The age of the patients ranged from 51 to 83 years. The average age was (65.39 鹵9.59) years old. Site of involvement: C 3 / 49, C 4 / 5, C 5 / 6, C 6 / 6, C 6 / 7, 15 cases. According to the percentage of the recovery degree of intervertebral space height to the reference height during the operation, 28 cases were divided into group A (immediate postoperative intervertebral height / target intervertebral space standard height was 100-120%). There were 63 cases in group B (120-140%) and 59 cases in group C (140-160%). Comparison showed that there was no significant difference in the distribution of surgical site in different groups of patients. The neurologic function relief, the incidence of cervical axial symptoms, the change of height of the target intervertebral space, and the degeneration of adjacent segments were compared before and after different group operations and at the last follow-up. To analyze the effect of different intervertebral space height recovery on clinical efficacy. The result is 1: 1. The age and sex of the three groups were analyzed by independent sample test between two groups, P0.05, there was no statistical significance, that is, there was no difference in age distribution among the three groups, indicating that the three groups were comparable. 2. The results of J0A analysis before operation showed that there was no statistical difference among the three groups. The scores of J 0A in the three groups were significantly improved after operation, and the differences were statistically significant compared with those before operation. The recovery rate of nerve function in group B was 71.88% higher than that in group C (68.62%), which was better than that in group A (42.25% -120-140%). The incidence of cervical axial symptoms in the three groups was 35.71% and 42.37% respectively 2 years after anterior cervical fusion. The incidence of axial symptoms in group A and group C was higher than that in group B. the height of intervertebral space between 120% and 140% in group B was the best choice. The height of intervertebral space in group B was higher than that in group A immediately after operation, but there was no significant difference between group B and C. To the last follow-up, the height loss of intervertebral space in group C was the largest, which was significantly different from that in group A and group B. At the mean follow-up of 2 years, the loss of the height of adjacent intervertebral space was the least in group B, and there was statistical difference between group A and group C (P < 0.05), but there was no statistical difference between group A and group C. Conclusion: through clinical retrospective study, we found that there were no severe complications such as excessive spinal cord traction in the 2-year follow-up period when the height of vertebral space recovered to 100-160% of the standard height, which was better than that before operation. With 120-160% datum height as the ideal height, the nerve function of J0A recovered better. Considering the axial symptoms of cervical spine after operation, the height loss of target intervertebral space and adjacent intervertebral space were followed up. The best standard height was 120-140%. It was recommended that the recovery height of ACDF intervertebral space be 120-140%.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3
，
本文編號：2329861
[Abstract]:Objective: to treat single segment cervical degenerative disease (Cervical degenerative disc disease,CDDD) with ACDF (anterior cervical disc resection, decompression, internal fixation and fusion). The effect of the recovery degree of intervertebral space height on clinical curative effect was discussed, so as to provide a reference and evaluation for the choice of appropriate intervertebral space open height in anterior cervical surgery. Methods: from January 2012 to December 2014, one hundred and fifty patients (95 male and 55 female) with single segment ACDF received CDDD in the first affiliated Hospital of Dalian Medical University were analyzed retrospectively. The age of the patients ranged from 51 to 83 years. The average age was (65.39 鹵9.59) years old. Site of involvement: C 3 / 49, C 4 / 5, C 5 / 6, C 6 / 6, C 6 / 7, 15 cases. According to the percentage of the recovery degree of intervertebral space height to the reference height during the operation, 28 cases were divided into group A (immediate postoperative intervertebral height / target intervertebral space standard height was 100-120%). There were 63 cases in group B (120-140%) and 59 cases in group C (140-160%). Comparison showed that there was no significant difference in the distribution of surgical site in different groups of patients. The neurologic function relief, the incidence of cervical axial symptoms, the change of height of the target intervertebral space, and the degeneration of adjacent segments were compared before and after different group operations and at the last follow-up. To analyze the effect of different intervertebral space height recovery on clinical efficacy. The result is 1: 1. The age and sex of the three groups were analyzed by independent sample test between two groups, P0.05, there was no statistical significance, that is, there was no difference in age distribution among the three groups, indicating that the three groups were comparable. 2. The results of J0A analysis before operation showed that there was no statistical difference among the three groups. The scores of J 0A in the three groups were significantly improved after operation, and the differences were statistically significant compared with those before operation. The recovery rate of nerve function in group B was 71.88% higher than that in group C (68.62%), which was better than that in group A (42.25% -120-140%). The incidence of cervical axial symptoms in the three groups was 35.71% and 42.37% respectively 2 years after anterior cervical fusion. The incidence of axial symptoms in group A and group C was higher than that in group B. the height of intervertebral space between 120% and 140% in group B was the best choice. The height of intervertebral space in group B was higher than that in group A immediately after operation, but there was no significant difference between group B and C. To the last follow-up, the height loss of intervertebral space in group C was the largest, which was significantly different from that in group A and group B. At the mean follow-up of 2 years, the loss of the height of adjacent intervertebral space was the least in group B, and there was statistical difference between group A and group C (P < 0.05), but there was no statistical difference between group A and group C. Conclusion: through clinical retrospective study, we found that there were no severe complications such as excessive spinal cord traction in the 2-year follow-up period when the height of vertebral space recovered to 100-160% of the standard height, which was better than that before operation. With 120-160% datum height as the ideal height, the nerve function of J0A recovered better. Considering the axial symptoms of cervical spine after operation, the height loss of target intervertebral space and adjacent intervertebral space were followed up. The best standard height was 120-140%. It was recommended that the recovery height of ACDF intervertebral space be 120-140%.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3
，
本文編號：2329861
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