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  本文關鍵詞：不同頸椎后路單開門椎管擴大成形術術后相關效對比分析　出處：《山西醫(yī)科大學》2016年碩士論文　論文類型：學位論文

  更多相關文章： 脊髓型頸椎病樞椎 單開門 融合率 軸性癥狀 神經(jīng)根麻痹

【摘要】：目的:對不同頸椎后路單開門椎管擴大成形術術后的療效及術后相關并發(fā)癥進行對比分析,并對其原因進行探討。方法:回顧性分析我院從2009年5月至2012年6月采用頸椎后路單開門椎管擴大成形術治療的脊髓型頸椎病患者181例,根據(jù)開門后固定方式不同,分為鈦板固定組與懸吊固定組(包括絲線懸吊固定組與錨釘懸吊固定組)。鈦板固定組96例;懸吊固定組85例,其中絲線懸吊固定組46例,錨釘懸吊固定組39例。對鈦板固定組與懸吊固定組做組間對比,并對傳統(tǒng)懸吊固定組做組內(nèi)對比。對比內(nèi)容包括JOA評分、手術時間、出血量、脊髓致壓程度(a/M)、頸椎總活動度(ROM)、開門角度、脊髓后移距離及術后并發(fā)癥等。結(jié)果:181例患者均獲得隨訪,隨訪時間都在2年以上。絲線懸吊固定組與錨釘懸吊固定組對比,兩組患者術前一般情況、手術時間、術中出血量、術后2年JOA評分改善率、術后頸椎總活動度丟失量、門軸側(cè)融合率及術后相關并發(fā)癥對比,差異均無統(tǒng)計學意義。鈦板固定組與懸吊固定組對比,術前一般情況、手術時間、術中出血量、術前及術后2年JOA評分、JOA評分改善率、脊髓后移距離、脊髓致壓程度(a/M)對比,差異均無統(tǒng)計學意義;鈦板固定組6例發(fā)生C5神經(jīng)根麻痹,懸吊固定組4例,兩組對比差異無統(tǒng)計學意義;術后3個月與6個月門軸側(cè)融合率,鈦板固定組均高于懸吊固定組,差異有統(tǒng)計學意義;術后6個月再關門發(fā)生率、頸椎總活動度丟失量、軸性癥狀發(fā)生率對比,懸吊固定組均明顯高于鈦板固定組,差異有統(tǒng)計學意義。結(jié)論:采用微型鈦板做開門側(cè)固定,可以達到充分脊髓減壓,獲得滿意神經(jīng)功能改善率,同時,與傳統(tǒng)懸吊固定相比,采用微型鈦板固定更有利于門軸側(cè)骨性愈合,防止再關門現(xiàn)象的發(fā)生,也可明顯減少術后頸椎活動度的丟失,降低軸性癥狀的發(fā)生率,臨床療效肯定。
[Abstract]:Objective: to compare the curative effect and postoperative complications of different posterior cervical open door laminoplasty. Methods: from May 2009 to June 2012, 181 patients with cervical Spondylotic myelopathy were treated with open door laminoplasty. According to the different fixation methods after opening door, they were divided into titanium plate fixation group and suspension fixation group (including wire suspension fixation group and anchor nail suspension fixation group, 96 cases of titanium plate fixation group; There were 85 cases in the suspension fixation group, 46 cases in the silk thread group and 39 cases in the anchor nail group. The comparison between the titanium plate fixation group and the suspension fixation group was made. The comparison included JOA score, operative time, bleeding volume, spinal cord compression degree, total motion of cervical spine, open door angle. Results 181 patients were followed up for more than 2 years. The time of operation, the amount of intraoperative bleeding, the improvement rate of JOA score 2 years after operation, the loss of total cervical movement after operation, the rate of portal-axial fusion and the postoperative complications were compared. There was no significant difference between the titanium plate fixation group and the suspension fixation group, the average preoperative condition, operation time, intraoperative bleeding volume, JOA score before and 2 years after operation were improved. There was no significant difference in the distance of spinal cord backward and the degree of spinal cord compression (A / M). There were 6 cases of C5 nerve root paralysis in titanium plate fixation group and 4 cases in suspension fixation group. There was no significant difference between the two groups. The rate of portal axial fusion at 3 and 6 months after operation was higher in the titanium plate fixation group than in the suspension fixation group, and the difference was statistically significant. Six months after operation, the incidence of reclosing, the loss of total cervical movement and the incidence of axial symptoms were significantly higher in the suspension fixation group than in the titanium plate fixation group. Conclusion: the decompression of spinal cord and satisfactory improvement rate of nerve function can be achieved by using mini-titanium plate to fix the open door side of the spinal cord. At the same time, compared with the traditional suspension fixation. The microplate fixation is more beneficial to the healing of hilar axial bone, prevents the phenomenon of reclosing, and can obviously reduce the loss of cervical movement and the incidence of axial symptoms after operation. The clinical effect is positive.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R687.3

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