本文選題：頸椎病 + 頸椎前路手術(shù)��； 參考：《浙江大學(xué)》2015年博士論文

【摘要】：研究目的： 通過臨床觀察和隨訪,多個指標(biāo)綜合評估頸椎前路椎體次全切除減壓融合術(shù)(anterior cervical corpectomy with fusion, ACCF)、應(yīng)用傳統(tǒng)鈦板聯(lián)合融合器進(jìn)行頸椎前路椎間盤切除減壓融合術(shù)(anterior cervical discectomy with fusion, ACDF)和Zero-P椎間融合器進(jìn)行頸椎前路椎間盤切除減壓融合術(shù)(ACDF)這三種頸前路減壓術(shù)后患者頸椎功能改善情況等。探討三種頸前路減壓術(shù)式的早期臨床療效,以期找到合適治療頸椎病的手術(shù)方式。 研究方法： 本研究回顧性地分析了2012年1月至2014年9月期間浙江大學(xué)醫(yī)學(xué)院附屬邵逸夫醫(yī)院收治的82例行頸前路減壓術(shù)的頸椎病患者。按所選用的頸前路減壓術(shù)式,分成A組為應(yīng)用Zero-P椎間融合器行ACDF術(shù)38例；B組為傳統(tǒng)鈦板聯(lián)合融合器進(jìn)行ACDF計(jì)25例；C組為應(yīng)用傳統(tǒng)鈦板聯(lián)合鈦網(wǎng)進(jìn)行ACCF共19例。通過比較各組患者的手術(shù)時(shí)間以及術(shù)前、術(shù)后和末次隨訪時(shí)疼痛視覺模擬評分(visual agalogue scale, VAS;10分法)、日本骨科學(xué)會(Japanese Orthopedic Association,JOA)17分評分法及椎間隙高度和Cobb角等影像學(xué)觀察指標(biāo),分析三種頸前路減壓術(shù)式的臨床療效。 研究結(jié)果： C組術(shù)中平均出血量(142.1±103.1ml)相較A組(64.7±56.0m1)及B組(60.4±34.2m1)多,且有統(tǒng)計(jì)學(xué)意義。三組間手術(shù)時(shí)間、住院時(shí)間比較并無統(tǒng)計(jì)學(xué)差異。三組患者末次隨訪JOA評分、VAS評分較術(shù)前均有提高(P0.05)；但三組間末次隨訪的平均JOA改善率間比較差異無統(tǒng)計(jì)學(xué)意義。A組患者末次隨訪椎間隙高度及融合節(jié)段Cobb角較術(shù)前有增加(P0.05)。各組患者間術(shù)后1天、末次隨訪的C2-7節(jié)段Cobb角無差異。研究結(jié)論：應(yīng)用Zero-P椎間融合器進(jìn)行ACDF、應(yīng)用傳統(tǒng)鈦板聯(lián)合融合器進(jìn)行ACDF和應(yīng)用傳統(tǒng)鈦板聯(lián)合鈦網(wǎng)進(jìn)行ACCF這三種頸前路減壓術(shù)式其術(shù)后臨床療效確切。但三種術(shù)式的臨床療效并無顯著性差異。應(yīng)用傳統(tǒng)鈦板聯(lián)合鈦網(wǎng)進(jìn)行ACCF相較另兩種頸前路減壓術(shù)式在術(shù)中出血量多。應(yīng)用Zero-P椎間融合器進(jìn)行ACDF相較另兩種頸前路減壓術(shù)式在末次隨訪時(shí)影像學(xué)上頸椎生理曲度得到明顯改善并維持,但是否可明確減少術(shù)后相鄰椎體節(jié)段的退變發(fā)生率仍需進(jìn)行更長時(shí)間的隨訪調(diào)查論證。
[Abstract]:Objectives of the study: Through clinical observation and follow-up, Multiple indexes were used to evaluate anterior cervical corpectomy with fusion, ACCF for anterior cervical corpectomy with fusion, fusion. Anterior cervical discectomy with fusion, ACDF) and Zero-P intervertebral fusion cage were performed with conventional titanium plate combined with cage for anterior discectomy and decompression fusion of anterior cervical vertebrae. The patients with anterior cervical decompression and fusion were treated with anterior cervical discectomy and decompression and fusion (ACDF). To explore the early clinical effect of three anterior cervical decompression methods in order to find suitable surgical treatment for cervical spondylosis. Research methods: From January 2012 to September 2014, 82 patients with cervical spondylosis treated with anterior cervical decompression were analyzed retrospectively. According to the method of anterior cervical decompression, the patients in group A were divided into two groups: group A (n = 38) underwent ACDF with Zero-P intervertebral fusion cage, group B (n = 25) ACDF with conventional titanium plate and cage, group C (n = 25) with traditional titanium plate and titanium mesh for ACCF (n = 19). By comparing the time of operation, preoperative, postoperative and follow-up visual analogue score (VAS) with visual agalogue scale, VAS; 10 method, Japanese Orthopedic Association (JOA17) score, intervertebral space height and Cobb angle, and so on, the patients in each group were assessed with visual analogue score (VAS), visual analogue score (VAS) and Japanese Orthopedic Association (JOAA). To analyze the clinical effect of three kinds of anterior cervical decompression. Results of the study: The average intraoperative bleeding volume in group C was 142.1 鹵103.1 ml, which was significantly higher than that in group A (64.7 鹵56.0 ml) and group B (60.4 鹵34.2 ml). There was no significant difference in operation time and hospital stay among the three groups. However, there was no significant difference in the average improvement rate of JOA between the three groups. The height of intervertebral space and the Cobb angle of fusion segment in the last follow-up of group A were significantly higher than those before operation (P 0.05). There was no difference in the Cobb angle of C 2-7 segment between the groups 1 day after operation and the last follow-up. Conclusion: using Zero-P interbody fusion cage, traditional titanium plate combined with cage for ACDF and traditional titanium plate combined with titanium mesh for ACCF are the three kinds of anterior cervical decompression methods. However, there was no significant difference in clinical efficacy among the three types of operations. Compared with the other two anterior cervical decompression methods, traditional titanium plate combined with titanium mesh had more blood loss during operation than other two anterior cervical decompression methods. Compared with the other two anterior cervical decompression methods, Zero-P interbody fusion cage was used to perform ACDF in the last follow-up. However, a longer follow-up study is needed to determine whether the incidence of degeneration in adjacent vertebral segments can be clearly reduced.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2015
【分類號】：R687.3

【共引文獻(xiàn)】

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本文編號：1841248