本文關鍵詞： 頸椎病 人工椎間盤置換術 頸椎前路減壓融合術 對比療效分析　出處：《青島大學》2017年碩士論文　論文類型：學位論文

【摘要】：背景:頸椎前路減壓融合內固定術(ACDF)造成手術節(jié)段活動度喪失,相鄰節(jié)段應力集中及活動度代償性增加,進而導致鄰近椎間盤退變引起臨床癥狀的病例越來越多,為了改善現狀,近年來部分學者將手術治療理念轉移到非融合技術上,頸椎人工椎間盤置換(CDR)作為一種新型非融合技術而被重視,逐漸應用于臨床并且取得了良好的效果,但隨著隨訪時間的延長,其缺點也日漸暴露,目前有關頸椎前路減壓融合內固定術(ACDF)與人工椎間盤置換術(CDR)臨床療效的對比研究逐漸展開,但尚未得出一致結論。目的:通過研究頸椎前路DISCOVER人工椎間盤置換與椎間融合內固定患者術后臨床和影像學結果,對比兩種術式治療頸椎病的療效。方法:回顧性分析2012年5月至2015年5月期間于青島大學附屬醫(yī)院脊柱外科接受手術治療的單節(jié)段頸椎病患者52例,因治療方式不同隨機分為頸椎人工椎間盤置換組(置換組)和頸椎前路減壓融合內固定組(融合組),其中置換組26例,融合組26例,分別于治療后3、12、24、36個月進行不同時間隨訪,應用日本矯形外科協會(JOA)評分、視覺模擬量表(VAS)評分、頸椎功能障礙指數(NDI)評分等脊髓功能評價指標和頸椎曲度指數(CCI)、置換節(jié)段活動度、鄰近節(jié)段活動度、異位骨化等影像學結果,進行統計學對比分析研究。結果:所有患者術后隨訪24-36個月不等,結果顯示,兩組患者治療后各時間段的JOA、SF-36評分較治療前增加(P0.05),VAS、NDI評分較治療前減少(P0.05),但兩組間比較差異無顯著性意義(P0.05);置換組術后3月、12月及末次隨訪時Odom‘s優(yōu)良率分別為92.3%、97.2%、97.2%,融合組術后3月、12月及末次隨訪時Odom‘s優(yōu)良率分別為91.0%、95.4%、93.2%,兩組術后優(yōu)良率較治療前均增加(P0.05),組間差異無顯著意義(P0.05);置換組治療后置換節(jié)段活動度(8.00±0.11)°與治療前(8.04±1.06)°相比,差異無顯著性意義(P0.05),融合組治療后融合節(jié)段活動度近乎喪失,差異有顯著性意義(P0.05);置換組治療后頸椎整體活動度(43.37±5.25)°與治療前(45.68±5.34)°差異無顯著性意義(P0.05),而融合組治療后頸椎整體活動度(38.96±4.26)°與治療前(44.64±4.57)°差異有顯著性意義(P0.05);置換組治療后3月、12月及末次隨訪時段頸椎曲度指數(CCI)較術前比較差異無顯著性意義(P0.05),融合組治療后3月、12月及末次隨訪時頸椎曲度指數(CCI)較術前比較差異有顯著性意義(P0.05),兩組間各時間段對比差異有顯著性意義(P0.05),置換組治療后末次隨訪時置換節(jié)段上階段活動度(8.72±1.50)°較術前(8.48±1.61)°、置換節(jié)段下階段活動度(8.26±1.34)°較術前(8.09±1.59)°差異均無顯著性意義(P0.05),融合組治療后末次隨訪時融合節(jié)段上階段活動度(10.78±1.30)°較術前(8.50±1.97)°、融合節(jié)段下階段活動度(9.03±1.26)°較術前(7.74±1.39)°差異均有顯著性意義(P0.05)。結論:DISCOVER頸椎人工椎間盤置換術(CDR)與頸椎前路減壓融合內固定術(ACDF)相比,在緩解術后癥狀,恢復神經功能方面無顯著差異,且患者術后早期即可恢復正常生活、工作,就短期隨訪而言,DISCOVER人工椎間盤置換術在保持頸椎置換節(jié)段的活動度,減少鄰近節(jié)段椎間盤退變、維持頸椎曲度方面更具有優(yōu)勢。
[Abstract]:Background: anterior cervical decompression and fusion with internal fixation (ACDF) by segment activity loss, adjacent segment stress concentration and activity of the compensatory increase, leading to the adjacent intervertebral disc degeneration caused by the increasing number of cases of clinical symptoms, in order to improve the situation, in recent years, scholars will be transferred to the concept of non fusion surgery technically, cervical artificial disc replacement (CDR) and is regarded as a new type of non fusion technology is gradually applied in the clinic and achieved good results, but with longer follow-up, its disadvantages are also increasingly exposed, the anterior cervical decompression and fusion with internal fixation (ACDF) and artificial disc replacement (CDR) a comparative study of the clinical efficacy of the gradual, but has not yet reached the same conclusion. Objective: through the clinical research of anterior cervical DISCOVER artificial disc replacement and interbody fusion and internal fixation and postoperative imaging The results, the results of the two types of surgical treatment of cervical spondylosis. Methods: a retrospective analysis from May 2012 to May 2015 in 52 patients with single segmental cervical spine surgery of Affiliated Hospital of Qiingdao University underwent surgery cases, because of different treatment methods were randomly divided into artificial cervical intervertebral disc replacement group (replacement group) and anterior cervical decompression and fusion the internal fixation group (fusion group), including 26 cases of replacement group, fusion group 26 cases were treated after 3,12,24,36 months of follow-up time, using the Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, neck disability index (NDI) score and the functional evaluation of cervical spinal cord curvature index (CCI), the replacement segment of the adjacent segment of the heterotopic ossification imaging, were statistically analyzed. Results: follow up ranged from 24-36 months in all patients after operation, results showed that, 涓ょ粍鎮(zhèn)ｈ，

本文編號：1552081