發(fā)布時(shí)間：2018-04-12 16:51

  本文選題：頸椎病 + 頸椎后路成形術(shù)��； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:探討頸椎后路單開(kāi)門(mén)椎管擴(kuò)大成形術(shù)門(mén)軸折斷與軸性癥狀的相關(guān)性。方法:納入自2014年11月至2016年11月在青島大學(xué)附屬醫(yī)院同一名醫(yī)師進(jìn)行頸椎后路椎管擴(kuò)大椎板成形術(shù),采用微型ARCH鈦板內(nèi)固定,且資料完整的共有67人,男47人,女20人,年齡41-78歲,平均65歲。手術(shù)開(kāi)門(mén)減壓節(jié)段在C3-C7共43例、在C3-C6共15例、在C4-C7共2例、在C4-C6共5例,記錄術(shù)后患者出現(xiàn)頸肩部酸脹、僵硬、沉降感及肌肉痙攣的發(fā)生情況及程度,軸性癥狀程度分類(lèi):沒(méi)有軸性癥狀(NO);經(jīng)常發(fā)生軸性癥狀,但是沒(méi)有影響到日�；顒�(dòng)(MILD);由于軸性癥狀影響到日常的生活和工作(SEVERE)。根據(jù)術(shù)后1周頸椎CT復(fù)查結(jié)果,將門(mén)軸側(cè)椎板折斷情況分為三類(lèi):1.不完全骨折;2.完全骨折骨斷端無(wú)移位;3.完全骨折骨斷端移位。復(fù)查術(shù)后3月、6月頸椎CT評(píng)估門(mén)軸側(cè)骨斷端愈合情況。隨訪患者神經(jīng)功能恢復(fù)情況(JOA評(píng)分、NDI評(píng)分、VAS評(píng)分)。進(jìn)行術(shù)后1周門(mén)軸側(cè)椎板折斷率與術(shù)后3月軸性癥狀發(fā)生率的相關(guān)性分析,術(shù)后1周門(mén)軸側(cè)椎板折斷類(lèi)型與術(shù)后3月軸性癥狀嚴(yán)重程度的相關(guān)性分析,并進(jìn)行術(shù)后6月門(mén)軸愈合率與軸性癥狀緩解率的相關(guān)性分析。結(jié)果:手術(shù)均順利完成,隨訪時(shí)間4-10個(gè)月,平均6個(gè)月,隨訪期間未發(fā)生螺釘松動(dòng)、鈦板移位及椎板再關(guān)門(mén)現(xiàn)象。由于術(shù)中門(mén)軸折斷導(dǎo)致椎板游離,直接切除3個(gè)椎板,共記錄295個(gè)椎板,共獲得6個(gè)月完整隨訪資料的脊髓型頸椎病患者67例。應(yīng)用定量資料t檢驗(yàn),比較手術(shù)前后JOA評(píng)分、VSA評(píng)分、NDI評(píng)分,具有顯著統(tǒng)計(jì)學(xué)意義(P0.01),術(shù)后1周門(mén)軸側(cè)椎板折斷率27.6%,共有81個(gè)椎板折段:不完全骨折37個(gè);完全骨折骨斷端無(wú)移位31個(gè);完全骨折骨斷端移位13個(gè)。發(fā)生術(shù)后椎板折斷病例50例,以椎板折斷較嚴(yán)重類(lèi)型記:不完全骨折19例;完全骨折骨斷端無(wú)移位18例;完全骨折骨斷端移位13例。術(shù)后3月軸性癥狀發(fā)生率為32/67:MILD18例(其中有3例患者術(shù)后1周復(fù)查頸椎CT門(mén)軸未見(jiàn)椎板骨折);SEVERE14例。術(shù)后6月84.2%病人門(mén)軸側(cè)椎板全部融合(椎板腹側(cè)及背側(cè)骨皮質(zhì)均愈合),軸性癥狀由SEVERE緩解至MILD、NO13例,由MILD緩解至NO10例,未見(jiàn)軸性癥狀加重患者。應(yīng)用卡方檢驗(yàn)分析術(shù)后1周門(mén)軸的折斷率與術(shù)后3月軸性癥狀的發(fā)生率的相關(guān)性,具有相關(guān)性(?2=9.23?20.05,1),分析術(shù)后1周門(mén)軸側(cè)椎板的折斷類(lèi)型與術(shù)后3月軸性癥狀程度的相關(guān)性,具有相關(guān)性(?2=18.996?20.05,4=7.81),分析術(shù)后6月門(mén)軸側(cè)椎板融合率與軸性癥狀緩解率的相關(guān)性,具有相關(guān)性(?2=5.79?20.05,1)。結(jié)論:頸椎后路單開(kāi)門(mén)椎管擴(kuò)大成形術(shù),采用微型鈦板內(nèi)固定,可改善脊髓及神經(jīng)根壓迫癥狀。術(shù)后門(mén)軸側(cè)的椎板折斷,尤其是門(mén)軸折斷并移位是術(shù)后軸性癥狀發(fā)生的主要原因之一,門(mén)軸融合可有效緩解術(shù)后軸性癥狀。
[Abstract]:Objective: to investigate the relationship between axial symptoms and fracture of portal axis in posterior cervical open door laminoplasty.Methods: from November 2014 to November 2016, 67 patients (47 males and 20 females) underwent posterior cervical vertebrae laminoplasty in Qingdao University affiliated Hospital.The age ranged from 41 to 78 years with an average of 65 years.Open door decompression was performed in 43 cases in C3-C7, 15 cases in C3-C6, 2 cases in C4-C7 and 5 cases in C4-C6. The occurrence and degree of acidosis, stiffness, sedimentation and muscle spasm were recorded.Degree of axial symptoms: no axial symptoms; often developed axial symptoms, but did not affect the daily activities of MILDD; due to axial symptoms affect daily life and work of SEVEREN.According to the results of cervical CT reexamination 1 week after operation, the fracture of the hilar axial lamina was divided into three types: 1: 1.Incomplete fracture 2.No displacement was found at the broken end of the bone in complete fracture.Displacement of broken end of bone in complete fracture.3 months after operation, 6 months after operation, cervical CT was used to evaluate the healing of the broken end of the hilar axial bone.The neurologic function recovery was evaluated by JOA score and NDI score and VAS score.The correlation between the healing rate of portal axis and the relief rate of axial symptoms was analyzed 6 months after operation.Results: all the operations were completed successfully, the follow-up time was 4-10 months (mean 6 months). No screw loosening, titanium plate displacement and lamina closure were observed during the follow-up period.Due to the dissociation of the lamina due to the fracture of the portal axis during the operation, three laminae were removed directly, 295 laminae were recorded, and 67 patients with cervical Spondylotic myelopathy were followed up for 6 months.T test of quantitative data was used to compare JOA score and JOA score before and after operation. There was significant statistical significance (P 0.01). 1 week after operation, the fracture rate of portal-axial lamina was 27.60.There were 81 laminar fractures: 37 incomplete fractures.There were 31 cases of complete fracture and 13 cases of complete fracture.There were 50 cases of fracture of vertebral lamina after operation, 19 cases of incomplete fracture, 18 cases of complete fracture without displacement, 13 cases of complete fracture of broken end of bone.Three months after operation, the incidence of axial symptoms was 32/67:MILD18 in 14 cases.In 84.2% of the patients, the hilar and axial laminae were fused at 6 months after operation. The axial symptoms were relieved from SEVERE to MILDN in 13 cases and from MILD to NO10 in 13 cases. There were no cases with aggravated axial symptoms.Chi-square test was used to analyze the correlation between the fracture rate of portal axis 1 week after operation and the incidence of axial symptoms at 3 months after operation. The correlation was found between the type of fracture of portal axial lamina 1 week after operation and the degree of axial symptoms at 3 months after operation.Conclusion: posterior open door laminoplasty and mini-titanium plate fixation can improve the compression symptoms of spinal cord and nerve root.The fracture of the lamina of the portal axis, especially the fracture and displacement of the portal axis, is one of the main causes of postoperative axial symptoms, and portal-axis fusion can effectively relieve the postoperative axial symptoms.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R687.3

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本文編號(hào)：1740601