本文關(guān)鍵詞： 平山病 內(nèi)固定融合術(shù) 療效 影像學(xué)　出處：《北京大學(xué)學(xué)報(醫(yī)學(xué)版)》2017年06期 　論文類型：期刊論文

【摘要】：目的:回顧性分析應(yīng)用頸前路融合內(nèi)固定術(shù)治療平山病的中期臨床及影像學(xué)結(jié)果,探討外科治療的意義和價值。方法:36例平山病患者采用頸椎前路融合鈦板內(nèi)固定術(shù)治療,觀察術(shù)后3個月、1年、2年時肌肉萎縮和肌力變化,測量術(shù)后C2-7頸椎活動度的改變及C4-7節(jié)段中立位頸椎MRI橫斷面脊髓面積的改變。結(jié)果:(1)臨床結(jié)果:除1例患者外,所有患者術(shù)后肌肉萎縮和肌無力無繼續(xù)進展。隨著時間推移,自覺肌無力改善的患者比例逐年增高:術(shù)后3個月為26.5%,術(shù)后1年為36.0%,術(shù)后2年時有85.7%的患者感覺肌力增加;同時肌萎縮改善的患者比例也逐年增高:術(shù)后3個月為8.8%,術(shù)后1年為24.0%,術(shù)后2年時有35.8%的患者感覺肌萎縮好轉(zhuǎn)。截至術(shù)后2年隨訪時段時,14例患者中有12例受累肌力改善,5例肌肉萎縮得到不同程度改善。(2)影像學(xué)結(jié)果:C2-7頸椎活動度術(shù)后較術(shù)前顯著減小,由術(shù)前平均62.25°±2.10°減少為術(shù)后2年時平均13.67°±7.51°(P0.01)。屈曲位MRI脊髓不再受到壓迫。頸椎各個節(jié)段MR橫斷面積:術(shù)后3個月時僅C6一個節(jié)段的面積較術(shù)前增大(P0.05);術(shù)后1年時C4-5-6三個節(jié)段面積均較術(shù)前增大(均為P0.01);術(shù)后2年時C4-5-6-7四個節(jié)段面積均較術(shù)前增大,其中C4脊髓面積增大15.60%、C5增大19.08%、C6增大21.60%、C7增大23.91%,與術(shù)前相比差異均具有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:前路內(nèi)固定植骨融合術(shù)是治療平山病的有效方法,可以獲得較好的中期臨床轉(zhuǎn)歸和影像學(xué)結(jié)果,對于控制平山病的發(fā)展和轉(zhuǎn)歸有著積極的意義和價值。
[Abstract]:Objective: to retrospectively analyze the mid-term clinical and imaging results of anterior cervical fusion and internal fixation in the treatment of Pingshan disease. Methods 36 patients with Pingshan disease were treated with anterior cervical fusion titanium plate fixation. The changes of muscle atrophy and muscle strength were observed at 3 months, 1 year and 2 years after operation. The changes of C2-7 cervical motion and the area of cervical MRI cross-sectional spinal cord in the neutral position of C4-7 were measured. Results the clinical results were as follows: except for one patient. With the passage of time, the proportion of patients with conscious myasthenia improved year by year: 26.5% in 3 months after operation and 36.0% in 1 year after operation. At 2 years after operation, 85.7% of the patients had increased sensory muscle strength. At the same time, the proportion of patients with improved muscular atrophy increased year by year: 8. 8 in 3 months after operation, and 24.0% in 1 year after operation. Sensory muscle atrophy was improved in 35.8% of the patients 2 years after operation, and 12 of 14 patients had improved muscle strength by the end of 2 years follow-up. The imaging results of 5 cases of muscular atrophy were significantly decreased after the operation of the cervical vertebrae motion of 1% C2-7 compared with that before operation. The mean value decreased from 62.25 擄鹵2.10 擄before operation to 13.67 擄鹵7.51 擄P0.01 at 2 years after operation. In flexion position, the spinal cord of MRI was no longer compressed. The transverse area of Mr of each segment of cervical spine: at 3 months after operation, the area of only one segment of C6 was increased compared with that of preoperation (P0.05). At 1 year after operation, the area of three segments of C4-5-6 was increased compared with that of preoperation (P 0.01). At 2 years after operation, the four segments of C4-5-6-7 increased, and the area of C4 spinal cord increased 15.60% and 19.08% and C6 increased 21.60% respectively. C7 increased 23.91, compared with the preoperative differences were statistically significant (P 0.05). Conclusion: anterior internal fixation fusion is an effective method for the treatment of Pingshan disease. It can obtain better clinical outcome and imaging results in the medium term, and has positive significance and value for controlling the development and outcome of Pingshan disease.
【作者單位】： 北京大學(xué)第三醫(yī)院骨科;北京大學(xué)國際醫(yī)院骨科;北京大學(xué)第三醫(yī)院神經(jīng)內(nèi)科;
【分類號】：R687.3
【正文快照】： 內(nèi)科,北京100191)△Corresponding author’s e-mail,sunyuor@vip.sina.com網(wǎng)絡(luò)出版時間:2017-10-19 10:11:10網(wǎng)絡(luò)出版地址:http://www.cnki.net/kcms/detail/11.4691.R.20171019.1011.008.html平山病(Hirayama disease,HD),又稱青少年上肢遠(yuǎn)端肌萎縮癥(juvenile muscular atr

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