【摘要】：目的:通過臨床觀察與病例隨訪,評價和分析頸前路椎體次全切術(shù)治療節(jié)段型頸椎后縱韌帶骨化癥臨床療效及其影響因素。并進一步探討頸椎后縱韌帶的認(rèn)識過程、發(fā)病機制、手術(shù)治療方式及前路手術(shù)的優(yōu)勢,為節(jié)段型頸椎后縱韌帶骨化癥的臨床治療提供客觀依據(jù)。方法:通過回顧分析自2010年10月至2015年3月在山東中醫(yī)藥大學(xué)附屬醫(yī)院脊柱骨科收治的37例行頸前路手術(shù)治療的節(jié)段型頸椎后縱韌帶骨化癥患者病歷及隨訪資料,采用日本骨科學(xué)會JOA評分系統(tǒng)評估手術(shù)療效。根據(jù)可能對手術(shù)療效有影響的若干因素,如:病程、椎管侵占率等,對手術(shù)療效進行統(tǒng)計學(xué)分析,并評估各因素對手術(shù)療效的影響。結(jié)果:患者JOA評分由術(shù)前(10.30±1.54)提高到(14.81±1.15),經(jīng)統(tǒng)計學(xué)檢驗p0.01,根據(jù)平林冽法評定患者末次隨訪神經(jīng)功能改善率,其總體優(yōu)良率91%,末次隨訪改善率(66.33±13.24)%,手術(shù)療效滿意。統(tǒng)計學(xué)分析顯示,患者病程(p0.05)、脊髓信號(p0.01)、椎管侵占率(p0.05)、骨化物形態(tài)(p0.05)與手術(shù)療效相關(guān),而外傷史在早期隨訪(p0.05)與手術(shù)療效相關(guān),末次隨訪(p0.05)不具有統(tǒng)計學(xué)意義。結(jié)論:頸前路椎體次全切術(shù)治療節(jié)段型頸椎OPLL療效確切,其直接解除骨化物對脊髓壓迫,達到即時穩(wěn)固,有效恢復(fù)頸椎生理曲度,具有直接、有效、徹底的特點,長期隨訪滿意。椎管侵占率、脊髓信號、病程、骨化物形態(tài)均會對手術(shù)療效產(chǎn)生不同程度的影響,外傷史在早期對手術(shù)療效有影響但隨訪末期未見影響。
[Abstract]:Objective: to evaluate and analyze the clinical effect and influencing factors of subtotal cervical vertebra resection in the treatment of ossification of cervical posterior longitudinal ligament by clinical observation and follow-up. The understanding process, pathogenesis, surgical treatment and advantages of anterior approach of cervical posterior longitudinal ligament were further discussed, which provided objective basis for clinical treatment of cervical posterior longitudinal ligament ossification. Methods: from October 2010 to March 2015, 37 cases of cervical posterior longitudinal ligament ossification treated by anterior cervical approach in the Department of Spinal Orthopaedics, affiliated Hospital of Shandong University of traditional Chinese Medicine, were retrospectively analyzed. The JOA scoring system of Japanese Orthopaedics Association was used to evaluate the outcome of the operation. According to several factors that may influence the curative effect of surgery, such as course of disease, spinal canal invasion rate and so on, the effect of operation is analyzed statistically, and the influence of each factor on the curative effect of operation is evaluated. Results: the JOA score of the patients was increased from (10.30 鹵1.54) to (14.81 鹵1.15). The improvement rate of nerve function was evaluated according to the method of Pinglinlie. The overall excellent and good rate was 91 and the improvement rate of the last follow-up was 66.33 鹵13.24. The operative effect was satisfactory. Statistical analysis showed that the course of disease (p0.05), spinal cord signal (p0.01), spinal canal invasion rate (p0.05), ossification morphology (p0.05) were correlated with the operative effect, but the history of trauma was correlated with the operative effect in the early follow-up (p0.05), but the last follow-up (p0.05) had no statistical significance. Conclusion: anterior cervical subtotal vertebra resection is effective in the treatment of segmental cervical OPLL. It can relieve the ossification directly from spinal cord compression, achieve immediate stability, and effectively restore the physiological curvature of cervical vertebrae. It has the characteristics of direct, effective and thorough. Long-term follow-up was satisfactory. The spinal canal invasion rate, spinal cord signal, course of disease and ossification morphology all had different effects on the operative effect. The traumatic history had influence on the surgical effect at the early stage but not at the end of follow-up.
【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】：2016
【分類號】：R687.3

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