發(fā)布時間：2018-07-21 14:03

【摘要】：目的:通過回顧30例頸椎后路手術(shù)患者,探討頸椎側(cè)塊螺釘內(nèi)固定治療頸椎疾病的有效性及安全性。方法:對2012年07月—2015年06月30例患者采用頸椎側(cè)塊螺釘內(nèi)固定治療頸椎疾病患者進行回顧性研究(本組病例中頸椎外傷16例,多節(jié)段脊髓型頸椎病12例,頸椎后縱韌帶骨化1例,頸椎管硬膜外自發(fā)性出血1例)。所有患者均采用后路減壓,側(cè)塊螺釘內(nèi)固定。其中有2例因考慮頸髓前方有髓核壓迫,二期行前路髓核摘除取植骨椎間融合鈦板內(nèi)固定術(shù)。所有病例分別在術(shù)前,術(shù)后,術(shù)后6個月采用ASIA評分系統(tǒng)和JOA評分系統(tǒng)對患者的神經(jīng)功能癥狀進行臨床效果評定,隨訪患者的復(fù)位,植骨融合情況及內(nèi)固定失效情況。結(jié)果:30例患者均獲得隨訪,隨訪6個月—3.5年,平均2年4個月;術(shù)后行X線攝片,頸椎MRI檢查;所有頸椎患者均完全復(fù)位。術(shù)后6個月所有患者均獲得良好的骨性融合。16例頸椎外傷患者(ASIA分級),5例A級(完全性頸髓損傷)患者中,1例術(shù)后6個月因反復(fù)肺部感染導(dǎo)致呼吸衰竭而死亡,2例恢復(fù)至B級,2例無恢復(fù);5例B級患者中,4例恢復(fù)至C級,1例無恢復(fù);4例C級患者中,3例恢復(fù)至E級,1例恢復(fù)至D級;2例D級患者均恢復(fù)至E級。術(shù)前、術(shù)后2周和術(shù)后6月ASIA分級Kruskal Wallis檢驗P=0.049。組間兩兩比較顯示術(shù)前和術(shù)后2周比較差異無顯著性(P=0.829),術(shù)前和術(shù)后6月JOA評分比較差異有顯著意義(P=0.024);多節(jié)段脊髓型頸椎病12例及頸椎后縱韌帶骨化1例,頸椎管硬膜外自發(fā)性出血1例,優(yōu)9例(改善率75%),良4例(改善率50%-75%),可1例(改善率50%)。術(shù)前、術(shù)后2周和術(shù)后6月JOA評分比較差異有顯著性,P=0.001(F=23.13)。組間比較顯示術(shù)前和術(shù)后2周JOA評分比較差異無顯著性(P=0.087),術(shù)前和術(shù)后6月JOA評分比較差異有顯著意義(P0.001)。所有病例均沒有出現(xiàn)神經(jīng)根,椎動脈,脊髓損傷或損傷加重的并發(fā)癥。結(jié)論:頸椎側(cè)塊螺釘內(nèi)固定具有力學(xué)強度好,適應(yīng)癥廣,操作安全等優(yōu)點,術(shù)后很大程度上保留了患者頸椎的活動度,是頸椎后路手術(shù)中一種安全,可靠的內(nèi)固定方法。
[Abstract]:Objective: to evaluate the efficacy and safety of cervical lateral mass screw fixation in the treatment of cervical spine diseases. Methods: from July 2012 to June 2015, 30 patients with cervical vertebrae disease were treated with cervical lateral mass screw fixation (16 cases of cervical trauma and 12 cases of multilevel cervical Spondylotic myelopathy). Ossification of posterior longitudinal ligament (1 case) and spontaneous epidural hemorrhage (1 case). All patients were treated with posterior decompression and lateral mass screw fixation. Among them, two cases were treated with anterior removal of nucleus pulposus and intervertebral fusion titanium plate fixation because of the compression of anterior medullary nucleus. The clinical effects of neurologic symptoms were evaluated by Asia scoring system and JOA scoring system before and 6 months after operation. The patients were followed up for reduction, bone graft fusion and failure of internal fixation. Results all 30 cases were followed up from 6 months to 3.5 years, with an average of 2 years and 4 months. 6 months after operation all patients obtained good osseous fusion. 16 patients with cervical spine trauma (Asia grade) and 5 patients with grade A (complete cervical spinal cord injury). 1 patient died of respiratory failure due to recurrent pulmonary infection 6 months after operation. Among the 5 patients with grade B, 4 cases recovered to grade C, 1 case had no recovery, 4 cases recovered to grade C, 3 cases recovered to grade E, 1 case recovered to grade D, 2 cases of grade D recovered to grade E. Before operation, 2 weeks after operation and 6 months after operation, Asia grade Kruskal Wallis was examined by P0. 049. There was no significant difference between the two groups before and after operation (P0. 829), there was significant difference in JOA score between preoperative and postoperative 6 months (P0. 024), 12 patients with multilevel cervical Spondylotic myelopathy and 1 with ossification of posterior longitudinal ligament of cervical spine. One case of spontaneous epidural hemorrhage in cervical spinal canal was excellent in 9 cases (75%), good in 4 cases (50-75%), and fair in 1 case (50%). There was a significant difference in JOA score between preoperative, postoperative 2 weeks and postoperative 6 months (P < 0.001). There was no significant difference in JOA score between the two groups (P0. 087), but there was a significant difference between the preoperative and postoperative 6 months JOA scores (P0. 001). There were no complications of nerve root, vertebral artery, spinal cord injury or aggravated injury in all cases. Conclusion: cervical lateral mass screw fixation has the advantages of good mechanical strength, wide indication, safe operation and so on. It is a safe and reliable internal fixation method in posterior cervical surgery.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R687.3

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