【摘要】：[目的]探討青年人頸椎病的臨床特點(diǎn)及頸前路手術(shù)效果。[方法]回顧性研究2006年1月~2015年7月在本院進(jìn)行頸前路椎間盤(pán)切除椎間植骨融合(ACDF)及頸椎體次全切除椎間植骨融合(ACCF)手術(shù)治療的48例年齡≤35歲的頸椎病患者,男28例,女20例,平均年齡(32.23±4.13)歲。結(jié)合病史及影像學(xué)資料,分析該類(lèi)患者的臨床特點(diǎn),通過(guò)比較術(shù)前、術(shù)后X線片Cobb’s角及頸椎弓深變化,以及頸椎JOA評(píng)分、VAS評(píng)分來(lái)評(píng)估前路手術(shù)治療效果。[結(jié)果]48例患者中,30歲以上37例,長(zhǎng)期伏案工作者(每d5 h)25例,工人農(nóng)民等重體力勞動(dòng)者12例,7例曾有過(guò)頸部外傷。平均病程(5.53±7.39)個(gè)月,平均隨訪(3.44±2.96)年,無(wú)失訪患者。脊髓型28例,神經(jīng)根型17例,混合型3例,共累及87個(gè)病變節(jié)段,其中C5、6節(jié)段最多,為34個(gè)。ACDF組及ACCF組分別為13例和35例。脊髓型患者神經(jīng)功能由術(shù)前的平均(10.35±1.96)分提高至(15.41±1.41)分,平均改善率為(77.8±17.3)%;神經(jīng)根型患者平均VAS評(píng)分由術(shù)前的(7.61±1.12)分降低為(0.64±0.61)分,Cobb's角由-15.3~23.1°恢復(fù)到-2.6~26.1°,改善了(9.25±4.52)°,頸椎弓深由(-10.1~9.1)mm恢復(fù)到(-3.5~10.7)mm,改善了(6.64±3.40)mm。兩種前路手術(shù)方式對(duì)神經(jīng)功能恢復(fù)、弧度恢復(fù)及弓深恢復(fù)無(wú)影響,ACCF組術(shù)中失血量大,頸椎弓深改變與Cobb's角改變有顯著關(guān)系。[結(jié)論]青年頸椎病多發(fā)于長(zhǎng)時(shí)間伏案工作或重體力勞動(dòng)人群,30歲以后明顯高發(fā),主要病理改變?yōu)轭i椎生理弧度的消失,頸前路手術(shù)可有效緩解疼痛,改善神經(jīng)功能、糾正頸椎生理曲度,除失血量外,兩種前路手術(shù)方式對(duì)結(jié)果無(wú)明顯影響。
[Abstract]:[Objective] to investigate the clinical characteristics of cervical spondylosis in young people and the effect of anterior cervical surgery. [Methods] a retrospective study was conducted in 48 cases of cervical spondylosis with age less than 35 years old, 28 males and 20 women, in July, ~2015, January 2006, which were treated by anterior cervical discectomy and interbody fusion (ACDF) and cervical spinal subtotal resection of intervertebral fusion (ACCF). The average age (32.23 + 4.13) years old. Combined with the medical history and imaging data, the clinical characteristics of the patients were analyzed. The preoperative, postoperative X-ray Cobb 's angle and the depth of the cervical arch, and the JOA score of the cervical vertebra, and the VAS score were used to evaluate the effect of the anterior approach. [results among the patients with]48, 37 cases above 30 years old and 25 of the long-term volt workers (each D5 h) 25) For example, 12 cases of heavy manual labourers such as workers and peasants, 7 cases of cervical trauma. The average course of disease (5.53 + 7.39) months, average follow-up (3.44 + 2.96) years, no missing patients. 28 cases of spinal cord, 17 cases of nerve root type, 3 cases of mixed type, involving 87 segment of C5,6 segment, among which 34 group and ACCF group are 13 cases and 35 cases respectively. The neurological function of the patients was increased to (15.41 + 1.41) points (15.41 + 1.41), and the average improvement rate was (77.8 + 17.3)%. The average VAS score of the patients with nerve root type decreased from (7.61 + 1.12) to (0.64 + 0.61), and the Cobb's angle was recovered from -15.3~23.1 to -2.6~26.1 degrees, improved (9.25 + 4.52) degrees, and the depth of the cervical spine was recovered from (-10.1~9.1) mm. To (-3.5~10.7) mm, the improvement of (6.64 + 3.40) mm. two kinds of anterior surgical methods had no effect on the recovery of nerve function, the restoration of radian and the restoration of the depth of the arch. There was a significant relationship between the amount of blood loss in the group ACCF and the change of the depth of the cervical spine with the change of Cobb's angle. [Conclusion] the young cervical spondylosis is mostly in the long time of the case of the case of the case or the heavy manual labor, and the obvious after 30 years of age. The main pathological changes are the disappearance of the physiological radian of the cervical spine. The anterior cervical surgery can effectively relieve the pain, improve the function of the nerve and correct the physiological curvature of the cervical vertebra. In addition to the amount of blood loss, the results of the two anterior surgical procedures have no obvious effect on the results.
【作者單位】： 南京醫(yī)科大學(xué)第一附屬醫(yī)院骨科;
【基金】：國(guó)家自然科學(xué)基金項(xiàng)目(編號(hào):81371967) 江蘇省“六大人才高峰”C類(lèi)資助項(xiàng)目(編號(hào):2014-WSN-012)
【分類(lèi)號(hào)】：R687.3

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