頸后路單開門椎管成形微型鈦板內(nèi)固定術(shù)治療多節(jié)段脊髓型頸椎病的早期臨床療效觀察
發(fā)布時間：2018-08-12 15:42
【摘要】：目的:探討頸后路單開門椎管成形微型鈦板內(nèi)固定術(shù)治療多節(jié)段脊髓型頸椎病的早期臨床療效,為進一步臨床應(yīng)用提供參考和依據(jù)。方法:回顧性分析2016年02月~2016年09月于山東省中醫(yī)院脊柱骨科采用頸后路單開門椎管成形微型鈦板內(nèi)固定術(shù)治療的多節(jié)段脊髓型頸椎病病例,依據(jù)納入及排除標準,共分析記錄患者19例,其中男13例,女6例,年齡33~75歲,平均年齡55歲。以定期門診復(fù)查、電話詢問等方式在患者出院后進行隨訪,隨訪時間6~13個月,平均9個月。詳細記錄19例患者術(shù)前、術(shù)后3個月、術(shù)后6個月及末次隨訪的JOA評分;術(shù)后3個月、術(shù)后6個月與末次隨訪的軸性癥狀;術(shù)前、術(shù)后3個月與術(shù)后6個月頸椎側(cè)位X線平片上椎管矢狀徑、頸椎曲度及SVA值;術(shù)后1周、術(shù)后6個月頸椎CT上椎板開門角度;術(shù)后6個月門軸側(cè)骨性融合狀況等資料,運用SPSS19.0統(tǒng)計學(xué)軟件對數(shù)據(jù)分析,以P0.05為差異具有統(tǒng)計學(xué)意義。結(jié)果:所有19例患者均獲完整隨訪,隨訪時間6~13個月,平均9個月。對數(shù)據(jù)統(tǒng)計分析后發(fā)現(xiàn):術(shù)后3個月、術(shù)后6個月及末次隨訪的JOA評分較術(shù)前均明顯增高,術(shù)前與術(shù)后3個月JOA及術(shù)后6個月JOA評分差異均有統(tǒng)計學(xué)意義(P0.05),術(shù)后3個月與術(shù)后末次隨訪JOA評分差異無統(tǒng)計學(xué)意義(P=0.1870.05);術(shù)后3個月軸性癥狀發(fā)生率21%,術(shù)后6個月軸性癥狀發(fā)生率15%,末次隨訪軸性癥狀發(fā)生率10%,術(shù)后軸性癥狀逐步改善;術(shù)后3個月及術(shù)后6個月椎管矢狀徑較術(shù)前均明顯擴大,術(shù)前椎管矢狀徑9.50±0.48mm,術(shù)后3個月椎管矢狀徑16.66±0.55mm,術(shù)后6個月椎管矢狀徑16.58±0.50mm,患者術(shù)前與術(shù)后3個月椎管矢狀徑差異有統(tǒng)計學(xué)意義(p=0.0030.05),術(shù)后3個月及術(shù)后6個月椎管椎管矢狀徑差異無統(tǒng)計學(xué)意義(p=0.130.05);術(shù)后SVA及頸椎曲度較術(shù)前變化不明顯;術(shù)前SVA為26.21±2.49mm,術(shù)后3個月SVA為26.89±2.26mm,術(shù)后6個月SVA為27.16±2.41mm,患者術(shù)前與術(shù)后3個月SVA數(shù)值差異無統(tǒng)計學(xué)意義(p=0.1140.05),患者術(shù)后3個月與術(shù)后6個月SVA數(shù)值差異無統(tǒng)計學(xué)意義(p=0.5560.05);術(shù)前頸椎曲度15±4.07°,術(shù)后3個月頸椎曲度14.26±3.46°,術(shù)后6個月頸椎曲度13.84±2.83°,術(shù)前與術(shù)后3個月頸椎曲度差異無統(tǒng)計學(xué)意義(p=0.1670.05),術(shù)后3個月及術(shù)后6個月頸椎曲度差異無統(tǒng)計學(xué)意義(p=0.4690.05);術(shù)后1周與術(shù)后6個月椎板開門角度變化不明顯,術(shù)后1周開門角度35.35±4.26°,術(shù)后6個月開門角度35.92±3.68°,差異無統(tǒng)計學(xué)意義(p0.05);術(shù)后6個月骨性融合率85%;術(shù)后椎動脈損傷1例,未見C5神經(jīng)根麻痹及再關(guān)門現(xiàn)象等其他并發(fā)癥。結(jié)論:對頸后路單開門椎管成形微型鈦板內(nèi)固定術(shù)治療多節(jié)段脊髓型頸椎病早期臨床療效分析后發(fā)現(xiàn),該術(shù)式有以下優(yōu)點:1.能有效擴大椎管矢狀徑并維持椎管矢狀徑和椎板開門角度的穩(wěn)定、有效改善神經(jīng)癥狀。2.對矢狀位平衡和頸椎生理曲度影響小。3.骨性融合率高。4.軸性癥狀發(fā)生率低且逐步緩解,其他并發(fā)癥少。頸后路單開門椎管成形微型鈦板內(nèi)固定術(shù)為治療多節(jié)段脊髓型頸椎病安全、有效方法。
[Abstract]:Objective: To investigate the early clinical effect of posterior cervical open-door laminoplasty and mini-titanium plate internal fixation in the treatment of multilevel cervical spondylotic myelopathy, and to provide reference and basis for further clinical application. According to the inclusion and exclusion criteria, 19 patients with multilevel cervical spondylotic myelopathy were analyzed and recorded, including 13 males and 6 females, aged 33-75 years, with an average age of 55 years. JOA score at preoperative, postoperative 3 months, 6 months and final follow-up; axial symptoms at 3 months, 6 months and final follow-up; sagittal diameter, cervical curvature and SVA on lateral cervical X-ray plain film at preoperative, 3 months and 6 months postoperatively; upper cervical vertebral lamina open angle at 1 week and 6 months postoperatively; portal axial bone at 6 months postoperatively Results: All 19 patients were followed up for 6-13 months, with an average of 9 months. The JOA scores of 3 months, 6 months and the last follow-up were significantly higher than those of preoperative. There was no significant difference in JOA score between preoperative and postoperative 3 months and 6 months (P = 0.1870.05). The incidence of axial symptoms was 21% at 3 months, 15% at 6 months, 10% at the last follow-up, and 10% at the last follow-up. The sagittal diameter of the spinal canal was significantly enlarged at 3 months and 6 months after operation. The sagittal diameter of the spinal canal was 9.50 (+ 0.48 mm) before operation, 16.66 (+ 0.55 mm) at 3 months after operation, and 16.58 (+ 0.50 mm) at 6 months after operation. The sagittal diameter of the spinal canal was significantly different from that at 3 months after operation (p = 0.0030.05). There was no significant difference in sagittal diameter of spinal canal 6 months after operation (p = 0.130.05); there was no significant difference in SVA and cervical curvature after operation; preoperative SVA was 26.21 (+ 2.49 mm), postoperative SVA was 26.89 (+ 2.26 mm) at 3 months, and postoperative SVA was 27.16 (+ 2.41 mm) at 6 months. There was no significant difference in SVA between preoperative and postoperative 3 months (p = 0.1140.05). There was no significant difference in SVA between 3 months and 6 months after operation (p = 0.5560.05); cervical curvature before operation was 15 [4.07], 3 months after operation was 14.26 [3.46], and 6 months after operation was 13.84 [2.83]. There was no significant difference in cervical curvature before operation and 3 months after operation (p = 0.1670.05). There was no significant difference in the opening angle of vertebral lamina between 1 week and 6 months after operation (p = 0.4690.05). The opening angle of vertebral lamina at 1 week and 6 months after operation was 35.35 [4.26], and that at 6 months after operation was 35.92 [3.68], with no significant difference (p 0.05); the rate of bone fusion at 6 months after operation was 85%; 1 case of vertebral artery injury, no C5 nerve root paralysis and re-closure were found. Conclusion: After analyzing the early clinical effect of posterior cervical open-door laminoplasty and mini-titanium plate fixation in the treatment of multi-level cervical spondylotic myelopathy, we found that this method has the following advantages: 1. It can effectively enlarge the sagittal diameter of the spinal canal, maintain the sagittal diameter of the spinal canal and the stability of the angle of opening the lamina, and effectively improve the neurological symptoms. The incidence of axial symptoms was low and gradually alleviated, and other complications were few. Posterior cervical open-door laminoplasty with mini-titanium plate internal fixation was a safe and effective method for the treatment of multilevel cervical spondylotic myelopathy.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3
本文編號：2179513
[Abstract]:Objective: To investigate the early clinical effect of posterior cervical open-door laminoplasty and mini-titanium plate internal fixation in the treatment of multilevel cervical spondylotic myelopathy, and to provide reference and basis for further clinical application. According to the inclusion and exclusion criteria, 19 patients with multilevel cervical spondylotic myelopathy were analyzed and recorded, including 13 males and 6 females, aged 33-75 years, with an average age of 55 years. JOA score at preoperative, postoperative 3 months, 6 months and final follow-up; axial symptoms at 3 months, 6 months and final follow-up; sagittal diameter, cervical curvature and SVA on lateral cervical X-ray plain film at preoperative, 3 months and 6 months postoperatively; upper cervical vertebral lamina open angle at 1 week and 6 months postoperatively; portal axial bone at 6 months postoperatively Results: All 19 patients were followed up for 6-13 months, with an average of 9 months. The JOA scores of 3 months, 6 months and the last follow-up were significantly higher than those of preoperative. There was no significant difference in JOA score between preoperative and postoperative 3 months and 6 months (P = 0.1870.05). The incidence of axial symptoms was 21% at 3 months, 15% at 6 months, 10% at the last follow-up, and 10% at the last follow-up. The sagittal diameter of the spinal canal was significantly enlarged at 3 months and 6 months after operation. The sagittal diameter of the spinal canal was 9.50 (+ 0.48 mm) before operation, 16.66 (+ 0.55 mm) at 3 months after operation, and 16.58 (+ 0.50 mm) at 6 months after operation. The sagittal diameter of the spinal canal was significantly different from that at 3 months after operation (p = 0.0030.05). There was no significant difference in sagittal diameter of spinal canal 6 months after operation (p = 0.130.05); there was no significant difference in SVA and cervical curvature after operation; preoperative SVA was 26.21 (+ 2.49 mm), postoperative SVA was 26.89 (+ 2.26 mm) at 3 months, and postoperative SVA was 27.16 (+ 2.41 mm) at 6 months. There was no significant difference in SVA between preoperative and postoperative 3 months (p = 0.1140.05). There was no significant difference in SVA between 3 months and 6 months after operation (p = 0.5560.05); cervical curvature before operation was 15 [4.07], 3 months after operation was 14.26 [3.46], and 6 months after operation was 13.84 [2.83]. There was no significant difference in cervical curvature before operation and 3 months after operation (p = 0.1670.05). There was no significant difference in the opening angle of vertebral lamina between 1 week and 6 months after operation (p = 0.4690.05). The opening angle of vertebral lamina at 1 week and 6 months after operation was 35.35 [4.26], and that at 6 months after operation was 35.92 [3.68], with no significant difference (p 0.05); the rate of bone fusion at 6 months after operation was 85%; 1 case of vertebral artery injury, no C5 nerve root paralysis and re-closure were found. Conclusion: After analyzing the early clinical effect of posterior cervical open-door laminoplasty and mini-titanium plate fixation in the treatment of multi-level cervical spondylotic myelopathy, we found that this method has the following advantages: 1. It can effectively enlarge the sagittal diameter of the spinal canal, maintain the sagittal diameter of the spinal canal and the stability of the angle of opening the lamina, and effectively improve the neurological symptoms. The incidence of axial symptoms was low and gradually alleviated, and other complications were few. Posterior cervical open-door laminoplasty with mini-titanium plate internal fixation was a safe and effective method for the treatment of multilevel cervical spondylotic myelopathy.
【學(xué)位授予單位】：山東中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.3
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