本文關(guān)鍵詞：顯微鏡輔助下前路與后-前路融合治療下頸椎骨折脫位的臨床療效分析　出處：《遵義醫(yī)學(xué)院》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 顯微鏡 下頸椎骨折脫位 前路 后-前路 植骨融合

【摘要】：目的:通過顯微鏡下和無顯微鏡下前路與后-前路融合治療下頸椎骨折脫位療效對比,探討顯微鏡在下頸椎骨折脫位手術(shù)中的優(yōu)點。方法:回顧性分析2007年1月-2015年1月收治的下頸椎骨折脫位合并脊髓損傷的患者51例。根據(jù)手術(shù)過程中是否使用顯微鏡分為兩組,其中顯微鏡組26例,行前路融合內(nèi)固定12例,行頸后-前路融合內(nèi)固定14例;無顯微鏡組25例,行前路融合內(nèi)固定13例,頸后-前路融合內(nèi)固定12例;按受傷部位分為:C3:8例,C4:11例,C5:17例,C6:10例,C7:5例。51例患者術(shù)后均獲得隨訪,隨訪13-26個月,平均隨訪14.2個月,分別比較顯微鏡和無顯微鏡的兩種術(shù)式在手術(shù)時間、術(shù)中失血量、神經(jīng)損傷恢復(fù)(ASIA分級)、術(shù)后改良JOA評分、術(shù)后癥狀改善率、Cobb角等指標(biāo)的差異,并觀察植骨愈合情況及有無并發(fā)癥發(fā)生。運用SPSS20.0軟件進行數(shù)據(jù)分析,P0.05認為差異有顯著統(tǒng)計意義。結(jié)果:術(shù)后隨訪復(fù)查提示所有頸椎脫位均復(fù)位良好,均無螺釘或鈦板松動、滑脫、斷裂,術(shù)后12個月隨訪時植骨均全部融合。顯微鏡下前路組12例:手術(shù)時間為70.4min±7.2min,術(shù)中失血量為113.3ml±15.6m1,術(shù)后ASIA功能分級均有不同程度的改善,改良JOA評分:術(shù)前7.37分±2.35分,術(shù)后1周13.34分±2.15分,術(shù)后改善率73.27%±18.79%,Cobb角:術(shù)前-4.4°±3.2°,術(shù)后1周6.8°±3.9°,術(shù)后12月6.1°±4.1°;術(shù)后無并發(fā)癥。后-前路組:手術(shù)時間為210.6±13.9min,術(shù)中失血量為226.6±37.8m1,術(shù)后ASIA功能分級均有不同程度的改善,改良JOA評分:術(shù)前7.19±1.26分;術(shù)后13.38±2.31分,術(shù)后改善率73.13%±18.43%;Cobb角:術(shù)前-5.2°±3.4°,術(shù)后1周6.8°±3.8°,術(shù)后12月6.7°±3.6°,術(shù)后切口感染1例。無顯微鏡組前路組13例:手術(shù)時間為81.2min±8.0min,術(shù)中失血量為158.3ml±20.3m1,術(shù)后ASIA功能分級1例無恢復(fù),其余均有不同程度的改善,改良JOA評分:術(shù)前7.52分±2.45分,術(shù)后1周11.97分±2.18分,術(shù)后改善率62.27%±21.77%,Cobb角:術(shù)前-4.8°±3.7°,術(shù)后1周6.5°±4.1°,術(shù)后12月6.6°±4.3°;術(shù)后聲音嘶啞2例,腦脊液漏2例,后-前路組:手術(shù)時間為230.0min±15.0min,術(shù)中失血量為316.6ml±61.0m1,術(shù)后ASIA功能分級1例無恢復(fù),其余均有不同程度的改善,改良JOA評分:術(shù)前7.28±1.26分;術(shù)后11.15分±2.79分,術(shù)后改善率62.13%±20.00%;Cobb角:術(shù)前-5.5°±3.1°,術(shù)后1周6.2°±3.9°,術(shù)后12月6.1°±3.1°。術(shù)后頸前部血腫2例。顯微鏡下前路組和后-前路組的手術(shù)時間、術(shù)中出血量明顯少于無顯微鏡組,差異均有統(tǒng)計學(xué)意義(P0.05)。顯微鏡前路組與后-前路組的術(shù)后JOA評分及術(shù)后改善率優(yōu)于無顯微鏡組,差異均有統(tǒng)計學(xué)意義(P0.05),而在Cobb角和植骨融合情況方面比較差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:顯微鏡輔助下前路與后-前路融合治療下頸椎骨折脫位的臨床療效優(yōu)于無顯微鏡手術(shù)組,顯微鏡下手術(shù)治療具有手術(shù)時間短、創(chuàng)傷小,出血少,安全性高,減壓效果確切等優(yōu)點。
[Abstract]:Objective: to compare the effect of anterior and posterior anterior fusion in the treatment of fracture and dislocation of lower cervical spine under microscope and without microscope. To explore the advantages of microscope in the operation of fracture and dislocation of lower cervical vertebra. A retrospective analysis of 51 patients with spinal cord injury associated with fracture and dislocation of the lower cervical spine from January 2007 to January 2015 was made. According to whether the microscope was used during the operation, the patients were divided into two groups. Among them, 26 cases in microscope group were treated with anterior fusion and internal fixation, and 14 cases were treated with posterior cervical fusion and anterior fusion internal fixation. In the group without microscope, 13 cases were treated with anterior fusion and 12 cases with anterior cervical fusion. According to the injury site, the patients were divided into 8 cases of C3: 8 cases of C4: 11 cases of C5: 17 cases of C6: 10 cases of C7: 10 cases of C7: 5 cases. 51 cases of patients were followed up for 13-26 months. The average follow-up time was 14.2 months. The operative time, blood loss, nerve injury recovery and improved JOA score were compared between the two types of operation under microscope and without microscope, respectively. The difference of symptom improvement rate and Cobb angle was observed. The union of bone graft and the occurrence of complications were observed. The data were analyzed by SPSS20.0 software. Results: all the cervical dislocation were well reduced and there was no screw or titanium plate loosening, slippage and rupture. All the bone grafts were fused at 12 months after operation. The operation time was 70.4 min 鹵7.2 min, and the blood loss was 113.3 ml 鹵15.6m1 in the anterior approach group under microscope (70.4 min 鹵7.2 min). The improved ASIA score was 7.37 鹵2.35 before operation and 13.34 鹵2.15 at 1 week after operation. The postoperative improvement rate was 73.27% 鹵18.79 and Cobb angle: -4.4 擄鹵3.2 擄before operation, 6.8 擄鹵3.9 擄at 1 week after operation, 6.1 擄鹵4.1 擄on December after operation. There were no postoperative complications. In the posterior anterior approach group, the operative time was 210.6 鹵13.9min, and the blood loss during operation was 226.6 鹵37.8 ml. The functional grading of ASIA was improved in different degree after operation. The modified JOA score was 7.19 鹵1.26 before operation. The postoperative improvement rate was 73.13% 鹵18.43 and 13.38 鹵2.31; The Cobb angle was -5.2 擄鹵3.4 擄before operation, 6.8 擄鹵3.8 擄at 1 week after operation and 6.7 擄鹵3.6 擄on December. The operative time was 81.2 min 鹵8.0 min, and the blood loss during operation was 158.3 ml 鹵20.3 ml. There was no recovery of ASIA functional grading in 1 case after operation. The other cases were improved in varying degrees. The modified JOA score was 7.52 鹵2.45 before operation and 11.97 鹵2.18 at 1 week after operation. The postoperative improvement rate was 62.27% 鹵21.77% and Cobb angle was 4.8 擄鹵3.7 擄before operation, 6.5 擄鹵4.1 擄at 1 week after operation and 6.6 擄鹵4.3 擄on December after operation. Postoperative hoarseness occurred in 2 cases, cerebrospinal fluid leakage in 2 cases. In the posterior anterior approach group, the operative time was 230.0min 鹵15.0min, and the blood loss during operation was 316.6 ml 鹵61.0 ml. There was no recovery in 1 case of ASIA functional grading after operation, and the others were improved to some extent. The modified JOA score was 7.28 鹵1.26 before operation. The postoperative improvement rate was 62.13% 鹵20.00 and 11.15 鹵2.79; The Cobb angle was 5.5 擄鹵3.1 擄before operation and 6.2 擄鹵3.9 擄at 1 week after operation. On December, 6. 1 擄鹵3. 1 擄. There were 2 cases of postoperative anterior cervical hematoma. The operative time of the anterior approach group and the posterior anterior approach group was significantly less than that of the no microscope group. The difference was statistically significant (P 0.05). The JOA score and the postoperative improvement rate of the anterior microscope group and the posterior anterior approach group were better than those of the no microscope group, and the difference was statistically significant (P 0.05). There was no significant difference in Cobb angle and bone graft fusion (P0.05). Conclusion: the clinical effect of microscopically assisted anterior and posterior anterior fusion in the treatment of fracture and dislocation of lower cervical spine is better than that in the group without microscope. The surgical treatment under microscope has the advantages of short operation time, less trauma, less bleeding, high safety, accurate decompression effect and so on.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R687.3

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