單開門椎板成形微鈦板固定治療脊髓型頸椎病
發(fā)布時間：2018-08-27 14:18
【摘要】：目的:探討單開門椎板成形微鈦板固定治療脊髓型頸椎病的臨床療效。方法:回顧性分析2013年1月至2014年3月于我院接受手術(shù)治療的脊髓型頸椎病患者49例,男37例,女12例,年齡56-71歲,平均年齡為60.2±2.6歲。將其隨機分為兩組,一組行頸后路單開門后以微鈦板固定,為微鈦板固定組;一組行頸后路單開門后以粗絲線縫合固定,為粗絲線縫合固定組。微鈦板固定組為男20例,女5例,粗絲線縫合固定組為男17例,女7例。患者均在術(shù)后三個月、六個月、十二個月門診復(fù)查,復(fù)查內(nèi)容主要為詢問并記錄患者自身感覺,醫(yī)生查體體征,常規(guī)拍攝頸椎X線、CT、MRI檢查,測量椎管前后徑指數(shù),測量開門角度,(Fig.1.1-1.2)評估椎管擴大率,與術(shù)前各項指標對比,采用(JOA評分標準)評價神經(jīng)功能,其最高分為17分,分值越高,表明神經(jīng)功能損害越輕。結(jié)果:微鈦板固定組:椎管擴大率32.6%±1.0%,平均術(shù)前JOA評分為(7.4±1.9),末次隨訪時為(13.2±1.8),改善率為62.3%。3例患者術(shù)后出現(xiàn)軸性癥狀,1例患者術(shù)后出現(xiàn)頸5神經(jīng)根麻痹癥狀,經(jīng)對癥治療后好轉(zhuǎn);所有患者末次隨訪時均未出現(xiàn)螺釘松動、微鈦板移位,開門側(cè)骨質(zhì)塌陷再次壓迫脊髓等并發(fā)癥,無再關(guān)門現(xiàn)象出現(xiàn)。粗絲線縫合固定組:椎板減壓范圍:椎管擴大率29.8%±1.5%,術(shù)前平均JOA評分為(8.3±1.4),末次隨訪時為(12.6±1.8),改善率為52.3%。3例發(fā)生“再關(guān)門”現(xiàn)象,1例患者術(shù)后出現(xiàn)軸性癥狀,2例患者術(shù)后出現(xiàn)頸5神經(jīng)根麻痹,經(jīng)對癥治療后好轉(zhuǎn);無傷口延遲愈合現(xiàn)象。結(jié)論:頸椎后路單開門椎板成形術(shù)中使用微鈦板固定,固定效果穩(wěn)定,術(shù)后可防止椎板因固定不牢導(dǎo)致的彈性回縮,能有效維持單開門術(shù)后的開門角度,能最大限度的防止“再關(guān)門”現(xiàn)象的發(fā)生,防止頸椎曲度丟失,減少軸性癥狀,是治療脊髓型頸椎病的有效方法。
[Abstract]:Objective: to investigate the clinical effect of single open-door laminoplasty microtitanium plate fixation for cervical Spondylotic myelopathy (Cervical Spondylotic Spondylotic myelopathy). Methods: from January 2013 to March 2014, 49 patients with cervical Spondylotic myelopathy, 37 males and 12 females, aged 56-71 years, with an average age of 60.2 鹵2.6 years, were analyzed retrospectively. They were randomly divided into two groups: one group was fixed with microtitanium plate after single open door through posterior cervical approach, the other group was fixed with coarse silk suture after single open door of cervical posterior approach. There were 20 males and 5 females in the microplate fixation group, and 17 males and 7 females in the coarse silk suture group. All the patients underwent outpatient reexamination at 3 months, 6 months and 12 months after operation. The main contents of the reexamination were to inquire and record the patient's own feeling, to record the physical signs of the patients, to take routine X-ray and CT MRI examination of the cervical spine, and to measure the anterior and posterior diameter index of the spinal canal. The open door angle (Fig.1.1-1.2) was used to evaluate the spinal canal enlargement rate. Compared with the preoperative indexes, the nerve function was evaluated by using (JOA score). The highest score was 17 points, the higher the score was, the lighter the nerve function damage was. Results: in the microtitanium plate fixation group, the spinal canal enlargement rate was 32.6% 鹵1.0, the average preoperative JOA score was (7.4 鹵1.9), and the last follow-up was (13.2 鹵1.8). The improvement rate was 62.3.3 cases with axial symptoms and 1 case with cervical 5 nerve root paralysis, which was improved after symptomatic treatment. At the last follow-up, there were no complications such as screw loosening, microtitanium plate displacement, bony collapse of the open door side and compression of the spinal cord, and no re-closing. In the coarse silk suture fixation group, the lamina decompression range: the spinal canal enlargement rate was 29.8% 鹵1.5%, the mean preoperative JOA score was (8.3 鹵1.4), and the last follow-up was (12.6 鹵1.8). The improvement rate was 52.3.3 cases with the phenomenon of "reclosing the door" and 1 case with axonal symptoms after operation. After the onset of cervical 5 nerve root paralysis, After symptomatic treatment, there was no delayed wound healing. Conclusion: the application of microtitanium plate fixation in posterior single-door laminoplasty of cervical vertebrae can prevent the elastic retraction of lamina laminae due to the unfastness of fixation, and can effectively maintain the open door angle after single door opening. It is an effective treatment for cervical Spondylotic myelopathy to prevent the occurrence of "reclosing", to prevent the loss of cervical curvature and to reduce the axial symptoms in the treatment of cervical Spondylotic myelopathy.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
本文編號：2207537
[Abstract]:Objective: to investigate the clinical effect of single open-door laminoplasty microtitanium plate fixation for cervical Spondylotic myelopathy (Cervical Spondylotic Spondylotic myelopathy). Methods: from January 2013 to March 2014, 49 patients with cervical Spondylotic myelopathy, 37 males and 12 females, aged 56-71 years, with an average age of 60.2 鹵2.6 years, were analyzed retrospectively. They were randomly divided into two groups: one group was fixed with microtitanium plate after single open door through posterior cervical approach, the other group was fixed with coarse silk suture after single open door of cervical posterior approach. There were 20 males and 5 females in the microplate fixation group, and 17 males and 7 females in the coarse silk suture group. All the patients underwent outpatient reexamination at 3 months, 6 months and 12 months after operation. The main contents of the reexamination were to inquire and record the patient's own feeling, to record the physical signs of the patients, to take routine X-ray and CT MRI examination of the cervical spine, and to measure the anterior and posterior diameter index of the spinal canal. The open door angle (Fig.1.1-1.2) was used to evaluate the spinal canal enlargement rate. Compared with the preoperative indexes, the nerve function was evaluated by using (JOA score). The highest score was 17 points, the higher the score was, the lighter the nerve function damage was. Results: in the microtitanium plate fixation group, the spinal canal enlargement rate was 32.6% 鹵1.0, the average preoperative JOA score was (7.4 鹵1.9), and the last follow-up was (13.2 鹵1.8). The improvement rate was 62.3.3 cases with axial symptoms and 1 case with cervical 5 nerve root paralysis, which was improved after symptomatic treatment. At the last follow-up, there were no complications such as screw loosening, microtitanium plate displacement, bony collapse of the open door side and compression of the spinal cord, and no re-closing. In the coarse silk suture fixation group, the lamina decompression range: the spinal canal enlargement rate was 29.8% 鹵1.5%, the mean preoperative JOA score was (8.3 鹵1.4), and the last follow-up was (12.6 鹵1.8). The improvement rate was 52.3.3 cases with the phenomenon of "reclosing the door" and 1 case with axonal symptoms after operation. After the onset of cervical 5 nerve root paralysis, After symptomatic treatment, there was no delayed wound healing. Conclusion: the application of microtitanium plate fixation in posterior single-door laminoplasty of cervical vertebrae can prevent the elastic retraction of lamina laminae due to the unfastness of fixation, and can effectively maintain the open door angle after single door opening. It is an effective treatment for cervical Spondylotic myelopathy to prevent the occurrence of "reclosing", to prevent the loss of cervical curvature and to reduce the axial symptoms in the treatment of cervical Spondylotic myelopathy.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.3
【參考文獻】
相關(guān)期刊論文 前1條
1 劉忠軍,黨耕町,蔡欽林;應(yīng)用單開門椎板成形術(shù)治療頸椎后縱韌帶骨化癥[J];中華骨科雜志;1999年06期
，本文編號：2207537
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