本文關(guān)鍵詞： 頸椎前路 減壓 膨脹螺釘 植骨融合 內(nèi)植物并發(fā)癥　出處：《吉林大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:對(duì)膨脹螺釘系統(tǒng)應(yīng)用于頸椎前路減壓植骨融合內(nèi)固定術(shù)后的中期臨床和影像學(xué)觀察和分析。材料和方法:21例頸椎術(shù)后患者納入該研究。男性14例,女性7例;年齡最小19歲,最大61歲,平均43.58歲;13例外傷所致,8例為頸椎間盤突出癥。減壓范圍:單一節(jié)段者8例,兩個(gè)節(jié)段者13例�；颊呔邮茴i椎前路膨脹螺釘系統(tǒng)行頸椎前路椎間隙減壓植骨融合內(nèi)固定術(shù)。術(shù)后患者隨訪時(shí)間從3個(gè)月到2年,平均9.7個(gè)月。術(shù)前和術(shù)后定期隨訪拍攝頸椎正側(cè)位和CT,觀測(cè)臨床療效,椎間高度,頸椎前凸曲度,內(nèi)植物融合情況,手術(shù)時(shí)間及出血量等手術(shù)情況。臨床療效通過JOA評(píng)分評(píng)定。應(yīng)用Excel進(jìn)行數(shù)據(jù)整理,采用SPSS20.0軟件進(jìn)行分析;患者術(shù)前、術(shù)后及末次隨訪時(shí)的頸椎曲度、椎間隙高度、JOA評(píng)分對(duì)比采用配伍組設(shè)計(jì)資料的方差分析方法,兩兩比較采用LSD法,以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:21例患者平均手術(shù)時(shí)間52.48min,平均出血量31.12ml。隨訪時(shí)間3個(gè)月到2年,平均9.7個(gè)月。術(shù)后JOA評(píng)分明顯提高(術(shù)前7.42±0.18,術(shù)后13.19±0.18,末次隨訪時(shí)14.24±0.18)。術(shù)前術(shù)后和末次隨訪時(shí)均有統(tǒng)計(jì)學(xué)意義。對(duì)患者頸椎曲度的測(cè)量(術(shù)前15.59±1.88、術(shù)后18.74±2.32、末次隨訪時(shí)16.63±1.73)差異有統(tǒng)計(jì)學(xué)意義(P0.001);采用LSD法進(jìn)行兩兩比較,患者術(shù)前與術(shù)后的頸椎曲度差異有統(tǒng)計(jì)學(xué)意義(P0.001),術(shù)前與末次隨訪時(shí)的頸椎曲度差異有統(tǒng)計(jì)學(xué)意義(P0.007),術(shù)后與末次隨訪時(shí)的頸椎曲度差異有統(tǒng)計(jì)學(xué)意義(P0.002)�；颊咦甸g隙高度(術(shù)前6.31±1.56、術(shù)后8.78±1.90、末次隨訪時(shí)7.59±1.70)差異有統(tǒng)計(jì)學(xué)意義(P0.001);采用LSD法進(jìn)行兩兩比較,患者術(shù)前與術(shù)后的椎間隙高度差異有統(tǒng)計(jì)學(xué)意義(P0.001),術(shù)前與末次隨訪時(shí)的椎間隙高度差異有統(tǒng)計(jì)學(xué)意義(P0.001),術(shù)后與末次隨訪時(shí)的椎間隙高度差異有統(tǒng)計(jì)學(xué)意義(P0.001)。所有患者術(shù)后內(nèi)固定融合率均為100%。至末次隨訪時(shí),無(wú)一例內(nèi)植物并發(fā)癥。結(jié)論:1.膨脹螺釘系統(tǒng)用于ACDF病例中,術(shù)后和末次隨訪時(shí)JOA評(píng)分均高于術(shù)前,且末次隨訪和術(shù)后相比,改善率提高明顯;2.該系統(tǒng)維持術(shù)后頸椎生理曲度滿意,保持了頸椎生物力學(xué)穩(wěn)定性;3.維持良好的椎間隙高度,為植骨塊與上下椎體間融合提供條件;4.術(shù)后12個(gè)月隨訪表明所有患者植骨均獲得骨性融合。
[Abstract]:Objective: to observe and analyze the clinical and imaging features of dilated screw system after anterior decompression, fusion and internal fixation. Materials and methods 21 cases of cervical vertebrae operation were included in the study, 14 males and 7 females; The age was 19 years old, the oldest was 61 years old, the average age was 43.58 years old, 13 cases were caused by cervical disc herniation. There were 13 cases with two segments. All patients were treated with anterior cervical vertebrae intervertebral space decompression and bone grafting and internal fixation. The follow-up period was from 3 months to 2 years. The mean time was 9.7 months. The anterior and lateral cervical vertebrae and CTS were recorded before and after operation, and the clinical efficacy, intervertebral height, curvature of cervical spine protruding and fusion of internal plants were observed. The clinical efficacy was evaluated by JOA score. The data were collected by Excel and analyzed by SPSS20.0 software. The cervical curvature of patients before, after operation and at the last follow-up was evaluated. The analysis of variance (ANOVA) method was used to evaluate the height of intervertebral space and the LSD method was used to compare the data of the matched group. Results the mean operation time was 52.48 minutes, and the average bleeding was 31.12 ml. The follow-up time was 3 months to 2 years. The JOA score increased significantly after operation (preoperative 7.42 鹵0.18, postoperative 13.19 鹵0.18, last follow-up 14.24 鹵0.18). There was a significant difference in cervical curvature between preoperative and last follow-up (15.59 鹵1.88, 18.74 鹵2.32, 16.63 鹵1.73, respectively). The difference was statistically significant (P 0.001). The results were compared by using LSD method. There was significant difference between preoperative and postoperative cervical curvature (P 0.001), between preoperative and last follow-up (P 0.007), and between postoperative and last follow-up (P 0.002). The difference of height (preoperative 6.31 鹵1.56, postoperative 8.78 鹵1.90, last follow-up 7.59 鹵1.70) was statistically significant (P 0.001). There was significant difference between preoperative and postoperative intervertebral space height (P 0.001), between preoperative and last follow-up (P 0.001), and between postoperation and last follow-up (P 0.001). The internal fixation fusion rate of all patients was 100 and 100%. No intra plant complications were found. Conclusion 1. The JOA score of ACDF patients after and at the last follow-up was higher than that in the last follow-up, and was higher in the last follow-up than that in the postoperatively. The improvement rate was significantly improved 2.The system maintained satisfactory physiological curvature of cervical spine after operation, maintained the biomechanical stability of cervical vertebrae and maintained a good height of intervertebral space. All the patients were followed up 12 months after operation and showed that bone fusion was achieved in all patients.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R687.3

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