本文選題：頸椎病 + 頸后路　； 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：1研究背景及目的傳統(tǒng)C3~C7頸椎后路椎管擴(kuò)大減壓術(shù)和單開(kāi)門(mén)椎管擴(kuò)大成形術(shù)是治療先天性頸椎管狹窄癥,多節(jié)段脊髓型頸椎病、頸椎黃韌帶及后縱韌帶肥厚和骨化等引起的繼發(fā)性廣泛性頸椎管狹窄癥的常見(jiàn)術(shù)式,已廣泛應(yīng)用于臨床數(shù)十年,其術(shù)后療效已得到充分的認(rèn)可,但此術(shù)式術(shù)后并發(fā)癥也逐漸被廣大醫(yī)生所認(rèn)識(shí),術(shù)后主要并發(fā)癥包括頸肩部軸性痛、頸椎生理性曲度丟失、頸椎活動(dòng)度下降、神經(jīng)根麻痹等。近年的研究發(fā)現(xiàn):頸椎后伸肌群對(duì)維持頸椎正常生理曲度及頸椎的穩(wěn)定性作用重要,術(shù)后頸椎生理曲度的丟失和軸性疼痛的產(chǎn)生與頸椎后路手術(shù)損傷后伸肌群及其止點(diǎn)有關(guān)。我們采用了責(zé)任節(jié)段椎管擴(kuò)大減壓術(shù),術(shù)中僅處理脊髓和神經(jīng)根受壓的節(jié)段,盡可能的保留非責(zé)任節(jié)段的棘突肌肉止點(diǎn),通過(guò)對(duì)責(zé)任節(jié)段頸后路椎管擴(kuò)大減壓術(shù)(包括成形術(shù))與傳統(tǒng)C3~C7節(jié)段頸后路減壓術(shù)(包括成形術(shù))治療多節(jié)段頸椎管狹窄癥的早期療效隨訪,對(duì)隨訪數(shù)據(jù)進(jìn)行分析,總結(jié)責(zé)任節(jié)段頸后路椎管擴(kuò)大減壓術(shù)(包括成形術(shù))術(shù)后療效。2方法回顧性分析自2013年1月到2016年1月在我院因多節(jié)段頸椎間盤(pán)突出、后縱韌帶骨化、黃韌帶肥厚所致的多節(jié)段頸椎管狹窄癥,在我院行頸后路手術(shù)的患者77例,責(zé)任節(jié)段頸后路椎管擴(kuò)大減壓術(shù)組(實(shí)驗(yàn)組)34例,傳統(tǒng)C3~C7節(jié)段頸后路減壓術(shù)組(對(duì)照組)43例,進(jìn)行早期隨訪調(diào)查研究,比較手術(shù)時(shí)間、手術(shù)出血量、術(shù)前及術(shù)后隨訪時(shí)JOA評(píng)分、VAS評(píng)分、神經(jīng)功能改善率等,進(jìn)行分析研究。3結(jié)果兩組患者術(shù)前與術(shù)后各階段隨訪JOA評(píng)分及神經(jīng)功能改善率差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),兩組患者術(shù)前及術(shù)后3月VAS評(píng)分差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),術(shù)后6、12月及末次隨訪VAS評(píng)分差異有統(tǒng)計(jì)學(xué)意義(P0.05),實(shí)驗(yàn)組優(yōu)于對(duì)照組。兩組術(shù)式術(shù)中出血量、手術(shù)時(shí)間差異有統(tǒng)計(jì)學(xué)意義(P0.05),實(shí)驗(yàn)組優(yōu)于對(duì)照組。4結(jié)論1.與傳統(tǒng)的C3~C7頸后路椎管擴(kuò)大減壓術(shù)比較,責(zé)任節(jié)段頸后路椎管擴(kuò)大減壓術(shù)同樣能取得良好的臨床療效;2.責(zé)任節(jié)段減壓手術(shù)時(shí)間短、術(shù)中出血量少;3.責(zé)任節(jié)段減壓術(shù)較傳統(tǒng)后路手術(shù)能夠能較好的改善患者早期的主觀疼痛癥狀。
[Abstract]:Background and objective traditional C3~C7 posterior spinal canal decompression and open door laminoplasty were used to treat congenital cervical spinal stenosis and multilevel cervical Spondylotic myelopathy. The common surgical procedures for secondary generalized cervical spinal canal stenosis caused by hypertrophy and ossification of ligamentum flavum and posterior longitudinal ligament have been widely used in clinical practice for decades. However, the complications of this operation have been gradually recognized by doctors. The main postoperative complications include neck and shoulder axial pain, loss of physiologic curvature of cervical vertebrae, decreased cervical movement, nerve root paralysis and so on. In recent years, it has been found that the posterior extensor muscle group plays an important role in maintaining the normal cervical curvature and the stability of the cervical spine. The loss of the cervical vertebra physiological curvature and the occurrence of axial pain are related to the extensor muscle group and its stopping point after posterior cervical surgery injury. We used the extended decompression of the responsible segmental spinal canal to treat only the spinal cord and nerve root compression segments, and to preserve as much as possible the spinous process muscle endpoints in the non-responsible segments. The early follow-up results of extended decompression of the responsible posterior cervical canal (including angioplasty) and traditional C3~C7 decompression (including angioplasty) in the treatment of multilevel cervical spinal stenosis were analyzed. To summarize the curative effect of extended decompression of the posterior cervical canal (including plasty). Methods from January 2013 to January 2016, we analyzed retrospectively the ossification of posterior longitudinal ligament due to multiple cervical disc herniation in our hospital. 77 cases of multilevel cervical spinal stenosis caused by hypertrophy of ligamentum flavum were treated by posterior cervical surgery in our hospital, and 34 cases were treated with extended decompression of posterior cervical spinal canal (experimental group, 34 cases), and 43 cases were treated with traditional C3~C7 posterior cervical decompression (control group, 43 cases). Early follow-up study was carried out to compare the operation time, the amount of blood loss, the JOA score before and after operation, the improvement rate of nerve function, and so on. Results there was no significant difference in JOA score and neurological function improvement rate between the two groups before and after operation (P 0.05). There was no significant difference in VAS score between the two groups before and 3 months after operation (P 0.05), but in 6 months and 12 months after operation, there was no significant difference in VAS score between the two groups. The difference of VAS score was statistically significant (P 0.05), and the experimental group was superior to the control group. There was significant difference in blood loss and operation time between the two groups (P 0.05), and the experimental group was superior to the control group (P 0.05). Conclusion 1. Compared with the traditional posterior cervical decompression with C3~C7, the extended decompression of the posterior cervical canal of the responsible segment can also obtain good clinical effect. The operative time of responsible segment decompression was short and the amount of blood lost during operation was less than 3%. Responsibility segmental decompression can improve patients' subjective pain symptoms better than traditional posterior approach.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

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