本文關(guān)鍵詞： 脊髓損傷 頸椎過伸傷 預(yù)后 影像學(xué) 相關(guān)因素 手術(shù)　出處：《揚(yáng)州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：頸椎過伸性損傷是一種常見的頸部脊髓損傷,有報導(dǎo)稱該類損傷占頸椎各類損傷的35%,本院統(tǒng)計表明該比率高達(dá)59.7%,通常有較輕微或隱匿性的骨損傷,當(dāng)無明顯骨性組織損傷或脫位時,常引起漏診。從而通過對頸椎過伸性損傷患者預(yù)后的相關(guān)因素進(jìn)行分析歸納具有重要的臨床意義。本研究在收集、整理揚(yáng)州市第一人民醫(yī)院近3年來頸椎過伸性損傷患者臨床資料的基礎(chǔ)上,分析影響頸椎過伸性損傷預(yù)后的相關(guān)因素,并結(jié)合X線、CT、MRI等影像檢查手段,分析頸椎過伸性損傷合并椎管狹窄的患者行手術(shù)治療后其預(yù)后的療效分析。研究目的1、本研究通過回顧性分析我院臨床相關(guān)數(shù)據(jù)資料,對近3年來我院頸椎過伸性損傷的臨床資料進(jìn)行歸納總結(jié),探討不同的預(yù)后因素。2、回顧性分析2013年-2016年來我院就診的17例頸椎過伸性損傷行手術(shù)治療的患者病例及影像學(xué)資料,探討頸椎過伸性損傷患者行手術(shù)治療的預(yù)后因素。材料與方法對揚(yáng)州市第一人民醫(yī)院骨科2013年一 2016年來我院就診的頸椎過伸性損傷患者的住院病歷進(jìn)行收集,共78例,分別從性別、年齡受傷機(jī)制等可能影響預(yù)后相關(guān)因素,根據(jù)患者術(shù)前癥狀、體征進(jìn)行入院ASIA評分,出院前進(jìn)行ASIA評分,計算得出好轉(zhuǎn)率。通過Spss17.0軟件使用卡方檢驗(yàn)和方差分析研究性別、年齡、脊髓損傷程度、傷前有無基礎(chǔ)病變、治療方式、早期改善情況是否存在差異。研究結(jié)果1、揚(yáng)州市第一人民醫(yī)院骨科2013年-2016年,收治的頸椎過伸性損傷患者共78例,共收集頸椎過伸傷病例78例,其中男性患者60例,女性患者18例。好轉(zhuǎn)率分別為55%,50%�；颊叨嗉性谥欣夏昊颊�,其中51~60歲及71~80歲患者最多。好轉(zhuǎn)率分別為76.5%,41.2%�；颊叩氖軅绞街饕熊嚨渹⒌�、撞傷、打架及其他原因?qū)е?主要集中在車禍傷(31例)和不慎跌倒(19例),兩者占總研究人數(shù)的64.1%。其中好轉(zhuǎn)率分別為51.6%,57.9%�；颊呷朐汉蟠蟛糠植∪诵斜Ｊ刂委熁蜣D(zhuǎn)院治療,患者行手術(shù)治療(17例)后,僅1例無明顯好轉(zhuǎn),其余患者均有好轉(zhuǎn)。手術(shù)治療與非手術(shù)治療兩者的好轉(zhuǎn)率94.1%和41.7%�；颊哂谢A(chǔ)病變(51例)多集中在中老年患者,治療好轉(zhuǎn)人數(shù)為21例,無基礎(chǔ)疾病患者(27例)治療后有20例出現(xiàn)好轉(zhuǎn)。兩者的好轉(zhuǎn)率分別為41.2%和74.1%。2、經(jīng)統(tǒng)計學(xué)分析發(fā)現(xiàn)性別、年齡、受傷方式與頸椎過伸傷員者的早期預(yù)后不具有統(tǒng)計學(xué)差異(P0.05)。脊髓損傷程度、有無傷前基礎(chǔ)病變和治療方式三方面具有統(tǒng)計學(xué)差異(P0.05)。手術(shù)組與保守組對比,差異具有統(tǒng)計學(xué)意義(P0.05)。手術(shù)組術(shù)前術(shù)后比較,差異具有統(tǒng)計學(xué)意義(P0.05)。結(jié)論1、性別、年齡、受傷方式與頸椎過伸傷員者的早期預(yù)后無明確的相關(guān)性。脊髓損傷程度、有無傷前基礎(chǔ)病變、手術(shù)與否與頸椎過伸傷員者的早期預(yù)后有明確的相關(guān)性。脊髓的損傷程度分級低,無傷前基礎(chǔ)病變及合理的手術(shù)治療都可以改善患者的預(yù)后。頸椎過伸傷的發(fā)病機(jī)制、手術(shù)時機(jī)的選擇、手術(shù)方式的選擇等問題應(yīng)獲得進(jìn)一步的研究,明確和細(xì)化手術(shù)的指征和時機(jī),發(fā)現(xiàn)其中可能隱藏的問題。2、手術(shù)治療的目的在于脊髓神經(jīng)充分減壓、維持或恢復(fù)頸椎的生理曲度和頸椎的穩(wěn)定性。早期手術(shù)減壓能減輕脊髓水腫,改善脊髓血液循環(huán),避免脊髓缺血變性壞死導(dǎo)致的二次損傷,手術(shù)技術(shù)的提高使頸椎能獲得即刻的穩(wěn)定,幫助患者早期功能鍛煉,減少各類并發(fā)癥的發(fā)生。
[Abstract]:Cervical hyperextension injury is a common injury of cervical spinal cord, there have been reports that the cervical injury accounted for 35% of all kinds of damage, the statistics show that the ratio of up to 59.7%, there are usually minor or occult bone injury, while no obvious bony tissue damage or dislocation, which often cause misdiagnosis. Through the relevant factors on the prognosis of patients with cervical hyperextension injury analysis has important clinical significance. This study summarized in the collection, collation of Yangzhou First People's Hospital in recent 3 years, the clinical data of cervical hyperextension injury patients on the basis of the analysis of the related factors affecting the prognosis of cervical hyperextension injury, combined with X-ray, CT, MRI etc. imaging methods, efficacy analysis of the prognosis of cervical hyperextension injury associated with spinal stenosis patients after surgical treatment. Objective: 1, through retrospective analysis of clinical data of this study, nearly 3 years of clinical data in our hospital of cervical hyperextension injury were summarized, to investigate the prognostic factors of.2 patients were retrospectively analyzed the cases and -2016 images of 2013 years in our hospital, 17 cases of cervical hyperextension injury of the surgical treatment of data, to investigate the prognostic factors of cervical hyperextension surgery for patients the cervical vertebra injury. Materials and methods in our hospital in 2013 2016 after a department of orthopedics of Yangzhou First People's Hospital hospitalized patients and injury were collected, a total of 78 cases, respectively, from the gender, age and mechanism of injury may affect the prognosis related factors, according to the preoperative symptoms and signs of admission ASIA score, ASIA score before discharge and calculated the improvement rate. Chi square test and variance analysis of gender, age by Spss17.0 software, the degree of spinal cord injury, before injury without basic disease, early treatment, improve Whether there are differences. Results: 1, the Department of orthopedics of Yangzhou First People's Hospital from 2013 -2016, cervical hyperextension injury patients with a total of 78 cases were collected in cervical hyperextension injury in 78 cases, including 60 cases of male patients and 18 female patients. The improvement rate was 55%, 50%. were more concentrated in the elderly patients, including 51~60 and 71~80 years old were the most. The improvement rate was 76.5%, were in the form of 41.2%. patients are injured, falls, bruises, causing fights and other reasons, mainly in traffic accident (31 cases) and fall (19 cases), the total number of 64.1%. in which the improvement rates were 51.6% most of the patients, 57.9%. patients received conservative treatment or referral treatment, patients underwent surgical treatment (17 cases), only 1 cases had no obvious improvement, the rest of the patients were improved. The non operation treatment and operation of the two improvement rate of 94.1% and 41.7%. In patients with underlying diseases (51 cases) and more concentrated in the elderly patients, 21 cases were cured, patients without underlying diseases (27 cases) after treatment, 20 cases improved. The improvement rate was 41.2% and 74.1%.2 respectively, the statistical analysis found that gender, age, injury and prognosis of early cervical hyperextension the wounded were not statistically significant (P0.05). The degree of spinal cord injury, there is no significant difference among the three basic pathological changes and treatment before injury (P0.05). Compared with the surgical group and the conservative group, the difference was statistically significant (P0.05). The surgery group before and after surgery, the difference was statistically significant (P0.05). Conclusion: 1, gender, age, no correlation with prognosis of early cervical hyperextension injury of the wounded. The degree of spinal cord injury, there is no pre injury basic disease, surgery and not with cervical hyperextension of the wounded after the early pre have a clear correlation of the spinal cord. The injury degree of lower grade, no pre injury based lesions and surgical treatment can improve the prognosis of the patients. The pathogenesis of cervical hyperextension injury, timing of surgery, surgical options should be given further research problems, and clear indications and timing refinement operation, which may find hidden problems.2, surgical treatment to spinal cord decompression and stability to maintain or restore cervical lordosis and cervical spine. Early surgical decompression can relieve spinal cord edema of spinal cord, improve blood circulation, to avoid the two injury of spinal cord ischemia necrosis caused by the improvement of surgical technique that can obtain immediate stability of the cervical spine, help early functional exercise patients, reduce complications.

【學(xué)位授予單位】：揚(yáng)州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3
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本文編號：1500420