【摘要】：目的觀察頸椎后路單開門椎管擴(kuò)大成形術(shù)結(jié)合側(cè)塊螺釘治療頸椎管狹窄伴頸椎不穩(wěn)的臨床療效。方法回顧性分析2012年5月至2015年6月收治的15例頸椎后路單開門椎管擴(kuò)大成形術(shù)結(jié)合側(cè)塊螺釘治療的頸椎管狹窄伴頸椎不穩(wěn)的患者,其中男13例,女2例;年齡36～84歲,平均59.6歲。致傷原因:高處墜落傷4例,交通事故傷4例,重物砸傷2例,摔傷5例。入院后均行頸椎正側(cè)位X線片、頸椎CT及MRI檢查,均接受頸椎的后路單開門椎管擴(kuò)大成形術(shù)結(jié)合側(cè)塊螺釘手術(shù)治療。比較患者術(shù)前及術(shù)后的頸椎JOA評(píng)分、VAS評(píng)分、C2-7Cobb角和椎體前滑移距離。末次隨訪時(shí)同時(shí)復(fù)查頸椎活動(dòng)度。結(jié)果所有患者均獲得隨訪,隨訪時(shí)間為12-20月,平均15.6個(gè)月。末次隨訪時(shí)JOA評(píng)分、VAS評(píng)分、C2-7Cobb角和椎體前滑移距離均顯著優(yōu)于術(shù)前,差異有統(tǒng)計(jì)學(xué)意義(P0.05)�；颊咝g(shù)后仍保留較好的頸椎活動(dòng)度,未發(fā)生內(nèi)固定松動(dòng)、斷裂等并發(fā)癥。結(jié)論采用頸椎后路單開門椎管擴(kuò)大成形術(shù)結(jié)合側(cè)塊螺釘治療頸椎管狹窄伴頸椎不穩(wěn)可使受壓頸髓充分減壓并獲得較好的頸椎穩(wěn)定性,是一種安全,有效的手術(shù)方式。
[Abstract]:Objective to observe the clinical effect of posterior open door laminoplasty combined with lateral mass screw in the treatment of cervical spinal stenosis with cervical instability. Methods from May 2012 to June 2015, 15 patients (13 males and 2 females) with cervical spinal stenosis associated with cervical instability treated by posterior open door laminoplasty combined with lateral mass screw were retrospectively analyzed. The average age is 59.6 years. The causes of injury were as follows: fall injury in 4 cases, traffic accident in 4 cases, heavy object injury in 2 cases and fall injury in 5 cases. After admission, all patients underwent X-ray film, CT and MRI examination. All patients were treated by posterior open door laminoplasty combined with lateral mass screw surgery. The cervical JOA scores were compared before and after operation with C 2-7 Cobb angle and anterior slip distance. At the last follow-up, the range of cervical vertebrae motion was reexamined at the same time. Results all patients were followed up for 12-20 months (mean 15.6 months). At the last follow-up, the JOA score and the C2-7 Cobb angle and the anterior slip distance of the vertebral body were significantly better than those before the operation, the difference was statistically significant (P0.05). The patient still retained good cervical mobility after operation, without internal fixation loosening, fracture and other complications. Conclusion posterior open door laminoplasty combined with lateral mass screw in the treatment of cervical spinal stenosis with cervical instability can fully decompress the compressed cervical spinal cord and obtain better cervical stability. It is a safe and effective surgical method.
【學(xué)位授予單位】：浙江大學(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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