發(fā)布時間：2018-06-13 23:45

  本文選題：頸椎病 + 神經(jīng)根型頸椎病��； 參考：《第二軍醫(yī)大學(xué)》2015年碩士論文

【摘要】：一、研究目的伴隨我國人口老齡化,頸椎病發(fā)病人數(shù)明顯增加,神經(jīng)根型頸椎病作為發(fā)病率最高的頸椎病(Cervical Spondylotic Radiculopathy, CSR)占其中60%。神經(jīng)根型頸椎病常導(dǎo)致頸肩背部疼痛、上肢及手指的放射性疼痛、麻木、無力,嚴(yán)重影響了人們的生活質(zhì)量。既往對于神經(jīng)根型頸椎病手術(shù)治療方法選擇及預(yù)后因素研究資料有限,在某些方面還存有爭議,臨床上對其認(rèn)識還不夠全面,常出現(xiàn)手術(shù)效果欠佳等情況,因此需要做更深入的研究。本研究主要研究神經(jīng)根型頸椎病外科治療方式及分析手術(shù)治療預(yù)后影響因素。二、研究方法1.前瞻性研究2012年9月至2014年1月長征醫(yī)院骨科收治的接受頸前路減壓人工椎間盤置換術(shù)和植骨融合內(nèi)固定術(shù)治療神經(jīng)根性頸椎病73例患者,其中男30例,女43例。采用隨機(jī)分組方式,依據(jù)患者選擇手術(shù)方式不同,分為兩組,即人工椎間盤置換術(shù)組(CTDR組)35例(男16例,女]9例),平均年齡45.7歲(24-65)；椎間融合術(shù)組(ACDF組)38例(男14例,女24例)平均年齡46.5歲。平均隨訪1.4年,比較兩組患者末次隨訪VAS(視覺模擬評分法)、NDI(頸部傷殘指數(shù))、SF-36PCS(生理部分PCS包含前4個維度的(PF、RP、BP和GH)、SF-36MCS(心理部分MCS包含了后4個維度(RE、SF、MH和VT))及手術(shù)相鄰節(jié)段活動度(ROM)。研究對比以上兩種手術(shù)方式治療神經(jīng)根型頸椎病的療效差異及對手術(shù)相鄰節(jié)段活動度的影響。2.回顧性研究2012年5月至2015年1月長征醫(yī)院骨科收治的接受頸前路減壓人工椎間盤置換術(shù)患者45例,根據(jù)NDI評分及術(shù)后復(fù)查結(jié)果確定治愈組與非治愈組。分析影響其手術(shù)效果相關(guān)因素。滿足以下條件者為治愈組：1、NDI評分15分改進(jìn)；2、手術(shù)節(jié)段神經(jīng)根功能未出現(xiàn)持續(xù)性功能減退；3、未出現(xiàn)手術(shù)失敗及二次手術(shù)；4、隨訪復(fù)查頸椎正側(cè)位、動力位及左右側(cè)屈X片未見人工椎間盤移位、活動受限及假體相關(guān)問題。以上4點不滿足其中1點既為非治愈組。預(yù)后因素分為背景資料因素及主觀變量因素。背景資料包括：性別,年齡,病程,吸煙習(xí)慣,肌電圖確診,肌力,手術(shù)節(jié)段,手術(shù)時間、出血量；主觀變量：VAS(視覺模擬評分法),NDI(頸部傷殘指數(shù))。三、研究結(jié)果1.經(jīng)過統(tǒng)計分析,人工椎間盤置換術(shù)組(CTDR)較椎間融合術(shù)組(ACDF)的出血量與手術(shù)時間無明顯差異(出血量CTDR組184.9±40.5ml, ACDF組191.1±53.9m1,P0.05,手術(shù)時CTDR組144.5±14.0min, ACDF組145.2±15.1min,P0.05)。隨訪期間所有患者均未發(fā)現(xiàn)假體及椎間融合器松動脫落移位等。兩組患者術(shù)后癥狀均比術(shù)前有明顯改善。ACDF組與CTDR組術(shù)前及末次隨VAS、NDI、SF-36PCS、SF-36MCS評分比較均無明顯差異(P0.05)；ACDF組末次隨訪手術(shù)相鄰上、下節(jié)段活動度與術(shù)前相比有明顯差異(P0.05)；CTDR組術(shù)前與術(shù)后手術(shù)節(jié)段活動度相比較無明顯差異,手術(shù)相鄰上節(jié)段與下節(jié)段活動度與術(shù)前想比較均未見明顯差異(P0.05)。2.治愈組為34人,未治愈組為11人,通過統(tǒng)計分析兩組背景資料及主觀變量,結(jié)果如下,患者年齡(p=0.012)、病程(p=0.007)、吸煙習(xí)慣(p=0.037)、肌電圖確診(p=0.007)、術(shù)前VAS(p0.001)、NDI (p0.001)對術(shù)后的恢復(fù)效果有統(tǒng)計學(xué)意義。性別(p=0.086),手術(shù)節(jié)段(p=0.260),頸椎ROM (p=0.521),手術(shù)時間(p=0.905)及出血量(p=0.543)對預(yù)后無統(tǒng)計學(xué)差異。四、結(jié)論：1.人工椎間盤置換術(shù)組與椎間融合術(shù)組隨訪發(fā)現(xiàn)兩種手術(shù)方式治療神經(jīng)根型頸椎病手術(shù)效果無明顯差別；人工椎間盤置換術(shù)不僅保留了手術(shù)節(jié)段的運(yùn)動功能同時減少了臨近節(jié)段影響：人工椎間盤置換術(shù)在治療神經(jīng)根型頸椎病是一種切實可行的手術(shù)方式。2.患者術(shù)前年齡小,病程短,低NDI評分,低VAS評分,無吸煙史,受壓神經(jīng)支配肌肉肌力高是預(yù)后的積極因素。性別、手術(shù)節(jié)段數(shù)量、術(shù)前手術(shù)節(jié)段活動度、手術(shù)時間、手術(shù)出血量等對預(yù)后無明顯影響。
[Abstract]:First, the study aims to increase the number of cervical spondylosis with the aging of the population in China. The cervical spondylosis of the nerve root type is the highest incidence of cervical spondylosis (Cervical Spondylotic Radiculopathy, CSR), and the cervical spondylosis of 60%. is often caused by the pain of the neck and shoulder, and the radiation pain, numbness and weakness of the upper limbs and the fingers are seriously affected. The quality of life of the people is limited. There are still some disputes about the choice of surgical treatment and the prognostic factors of the cervical spondylosis of the nerve root type. Two, study method 1. prospective study of 73 patients with Radicular Cervical Spondylosis Treated by anterior cervical decompression artificial disc replacement and implant fusion internal fixation in Department of orthopedics of Changzheng Hospital from September 2012 to January 2014, including 30 male and 43 female patients, which were randomly divided into groups. According to the choice of surgical methods, two groups were divided into two groups: artificial disc replacement (group CTDR) 35 cases (male 16, female]9), average age 45.7 years (24-65); interbody fusion group (group ACDF) 38 cases (male 14, female 24) average age 46.5 years old. Average follow-up 1.4 years, compared to group two patients last follow-up VAS (visual analogue scoring), NDI (neck (neck)), NDI (neck) SF-36PCS (physiological part PCS contains the first 4 dimensions (PF, RP, BP and GH), SF-36MCS (psychological part MCS contains the last 4 dimensions (RE, SF, MH and VT)) and the adjacent segments of the operation. The study compares the difference between the curative effects of the two surgical methods for the treatment of the cervical spondylosis of the deity and the activity of the adjacent segments of the operation A retrospective study of 45 patients receiving cervical anterior decompression and disc replacement admitted in Department of orthopedics of the Changzheng Hospital from May 2012 to January 2015. According to the NDI score and the reexamination results, the curative and non cured groups were determined. The factors affecting the surgical results were analyzed. The following conditions were treated as the cure group: 1, the NDI score was improved by 15 points; 2, hand. There was no persistent dysfunction in the nerve root function of the segment; 3, no surgical failure and two operations were not appeared; 4, follow-up examination of cervical vertebra positive lateral position, power position and left and right lateral flexion X films did not have artificial intervertebral disc displacement, movement restriction and prosthesis related problems. The above 4 points were not satisfied with 1 points not cured. The prognostic factors were divided into background data. Background data including sex, age, course of disease, smoking habits, electromyogram diagnosis, muscle strength, surgical segment, operation time, bleeding volume; subjective variables: VAS (visual analogue score), NDI (cervical disability index). Three, 1. by statistical analysis, artificial disc replacement group (CTDR) compared with interbody fusion group (CTDR) There was no significant difference between the bleeding volume of ACDF and the operation time (group CTDR 184.9 + 40.5ml, group ACDF, 191.1 + 53.9m1, P0.05, CTDR group 144.5 + 14.0min, ACDF 145.2 + 15.1min, P0.05). No prosthesis and interbody fusion exfoliation and displacement were found in all patients during the follow-up period. The postoperative symptoms of the two groups were significantly better than those before the operation. There was no significant difference between.ACDF group and group CTDR before and after the operation of VAS, NDI, SF-36PCS and SF-36MCS (P0.05). The activity degree of the lower segment in the last follow-up operation of ACDF group was significantly different from that before the operation (P0.05), and there was no significant difference between the preoperative and postoperative segment activity of the CTDR group, and the operation adjacent to the upper and lower segments was adjacent to the operation. There was no significant difference between the activity degree and the preoperative thought (P0.05).2. cured group was 34, and the uncured group was 11. Through statistical analysis of two groups of background data and subjective variables, the results were as follows: patient's age (p=0.012), course of disease (p=0.007), smoking habit (p=0.037), electromyography (p=0.007), preoperative VAS (p0.001), NDI (p0.001) to postoperative recovery effect. The results were statistically significant. There was no statistical difference between sex (p=0.086), surgical segment (p=0.260), cervical ROM (p=0.521), operation time (p=0.905) and bleeding volume (p=0.543). Four. Conclusion: 1. the results of two surgical methods for the treatment of cervical spondylotic radicular spondylosis have no significant difference in the group of artificial disc replacement and interbody fusion. Artificial disc replacement not only preserves the movement function of the segment of the operation, but also reduces the influence of adjacent segments: artificial disc replacement in the treatment of Radicular Cervical spondylosis is a practical way of surgical treatment of.2. patients with small preoperative age, short course of disease, low NDI score, low VAS score, no smoking history, and muscle muscle strength controlled by compression nerve. Height is a positive factor for prognosis. Gender, number of operative segments, preoperative operative segment activity, operative time, and operative blood loss have no significant effect on prognosis.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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本文編號：2016030