【摘要】：目的:探討頸后路單開(kāi)門(mén)椎管擴(kuò)大成形術(shù)后曲度變化與神經(jīng)功能改善、疼痛癥狀緩解、軸性癥狀發(fā)生率的關(guān)系及臨床意義。方法:回顧我院2011年1月~2015年12月收治的多節(jié)段脊髓型頸椎病(cervical spondylotic myelopathy,CMS)患者55例,分為兩組并分別用兩種手術(shù)方式行頸后路單開(kāi)門(mén)椎管擴(kuò)大成形術(shù)。A組行傳統(tǒng)絲線懸吊法頸后路單開(kāi)門(mén)椎管擴(kuò)大成形術(shù)23例,男性15例,女性8例,平均57.1歲(42-75歲)。B組行微型鈦板固定法椎管成形術(shù)32例,男性21例,女性11例,平均56.6歲(47-68歲)。對(duì)兩組患者術(shù)前及術(shù)后進(jìn)行JOA評(píng)分(Japanese Orthopaedic Association Scores)并計(jì)算神經(jīng)功能恢復(fù)率,手術(shù)前后行VAS評(píng)分(visual analogue scale)評(píng)估患者手術(shù)前后疼痛恢復(fù)情況,通過(guò)手術(shù)前后頸椎X線檢查,測(cè)量并計(jì)算頸椎曲度指數(shù)CCI(cervical curvature index)的丟失,隨訪兩組患者術(shù)后軸性癥狀的嚴(yán)重程度并計(jì)算其發(fā)病率,對(duì)以上所得數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:兩組術(shù)后均獲得隨訪,時(shí)間為15-39個(gè)月,平均18個(gè)月。兩組患者神經(jīng)功能與術(shù)前比較均獲得明顯改善,JOA評(píng)分恢復(fù)率,A組患者為(60.2±15.2)%,B組患者為(62.8±13.4)%,但兩組差異無(wú)統(tǒng)計(jì)學(xué)意義。兩組患者術(shù)后疼痛均得到緩解,VAS評(píng)分,A組為(2.14±1.78),B組為(2.55±1.33),差異有統(tǒng)計(jì)學(xué)意義。兩組患者術(shù)后頸椎曲度都有不同程度的丟失,A組患者丟失指數(shù)為(4.5±2.5)%,B組患者為(2.8±2.5)%,兩組差異有統(tǒng)計(jì)學(xué)意義,且A組曲度丟失明顯大于B組。軸性癥狀發(fā)病率,A組為39.13%,B組為18.75%,差異有統(tǒng)計(jì)學(xué)意義,且A組高于B組。結(jié)論:1.微型鈦板固定法頸后路單開(kāi)門(mén)椎管擴(kuò)大成形術(shù)和傳統(tǒng)絲線懸吊法椎管成形術(shù)治療多節(jié)段脊髓型頸椎病,都能得到很好的神經(jīng)功能改善。2.相比傳統(tǒng)絲線懸吊法椎管成形術(shù),微型鈦板固定法頸后路單開(kāi)門(mén)椎管擴(kuò)大成形術(shù)對(duì)頸椎穩(wěn)定性效果更好,可減少頸椎曲度的丟失。3.頸椎生理曲度的丟失與軸性癥狀的發(fā)病率有一定的相關(guān)性,防止頸椎生理曲度的丟失,能有效防止軸性癥狀的發(fā)生。
[Abstract]:Objective: to investigate the relationship between the changes of curvature and the improvement of nerve function, the relief of pain symptoms, and the incidence of axial symptoms in posterior cervical open door laminoplasty. Methods: from January 2011 to December 2015, 55 patients with multilevel cervical Spondylotic myelopathy (cervical spondylotic myelopathy,CMS) were retrospectively reviewed. Two groups were divided into two groups, 23 cases were treated with traditional filament-suspension single open door laminoplasty, 15 cases were males and 8 cases were females. The mean age was 57.1 years (42-75 years). Group B was treated with mini-titanium plate fixation in 32 cases, male 21 cases, female 11 cases, mean 56.6 years (47-68 years). Before and after operation, JOA score (Japanese Orthopaedic Association Scores) and neural function recovery rate were calculated, VAS score (visual analogue scale) was used before and after operation to evaluate the pain recovery of patients before and after operation, and the cervical spine X-ray was performed before and after operation. The loss of cervical curvature index (CCI (cervical curvature index) was measured and calculated. The severity and incidence of axial symptoms were measured and calculated. The above data were analyzed statistically. Results: both groups were followed up for 15-39 months (mean 18 months). The recovery rate of JOA score in group A was (60.2 鹵15.2) and (62.8 鹵13.4) in group B, but there was no significant difference between the two groups. The VAS score of group A was (2.14 鹵1.78) and group B was (2.55 鹵1.33), the difference was statistically significant. The loss index of cervical curvature in group A was (4.5 鹵2.5) and that in group B was (2.8 鹵2.5), the difference was statistically significant, and the loss of curvature in group A was significantly higher than that in group B. The incidence of axial symptoms was higher in group A than in group B (39.13% vs 18.75%), and higher in group A than in group B. Conclusion 1. The treatment of multilevel cervical Spondylotic myelopathy with mini-titanium plate fixation with single open door laminoplasty and traditional filament-suspension laminoplasty can improve the neurologic function of patients with cervical Spondylotic myelopathy. Compared with the traditional filament-suspension laminoplasty, the micro-titanium plate fixation single open door laminoplasty has better effect on the stability of the cervical spine, and can reduce the loss of cervical curvature by .3. There is a certain correlation between the loss of physiological curvature of cervical vertebrae and the incidence of axial symptoms. Preventing the loss of physiological curvature of cervical vertebrae can effectively prevent the occurrence of axial symptoms.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R687.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 桑裴銘;張明;陳斌輝;蔡暢;顧仕榮;裘成莉;;加巴噴丁治療頸椎術(shù)后軸性癥狀的臨床療效評(píng)價(jià)[J];中國(guó)臨床藥理學(xué)雜志;2013年02期

2 常曉盼;翟明玉;鄭偉;;藥物口服配合針刺療法治療頸椎術(shù)后軸性癥狀的療效觀察[J];中醫(yī)正骨;2012年01期

3 陳敢峰;;中藥熏蒸加電子生物反饋療法治療頸椎術(shù)后軸性癥狀臨床觀察[J];世界中西醫(yī)結(jié)合雜志;2008年11期

4 曹俊明;申勇;楊大龍;丁文元;孟憲中;張為;李志遠(yuǎn);;Bryan人工頸椎間盤(pán)置換與頸前路椎間融合術(shù)后軸性癥狀的對(duì)比分析[J];中國(guó)修復(fù)重建外科雜志;2008年10期

5 孫宇;;關(guān)于軸性癥狀[J];中國(guó)脊柱脊髓雜志;2008年04期

6 張為;董玉昌;申勇;丁文元;張標(biāo);李寶俊;姚曉光;;保留頸半棘肌肌止的椎板成形術(shù)的臨床應(yīng)用[J];中國(guó)矯形外科雜志;2006年13期

7 王春麗;杜良杰;;頸椎椎管擴(kuò)大成形術(shù)后生理曲度惡化的相關(guān)因素分析[J];鄭州大學(xué)學(xué)報(bào)(醫(yī)學(xué)版);2006年02期

8 曾巖,黨耕町,馬慶軍;頸椎前路術(shù)后融合節(jié)段曲度變化與軸性癥狀和神經(jīng)功能的相關(guān)性研究[J];中國(guó)脊柱脊髓雜志;2004年09期

9 孫宇,張鳳山,潘勝發(fā),王少波,李邁,張立;“錨定法”改良單開(kāi)門(mén)椎管成形術(shù)及其臨床應(yīng)用[J];中國(guó)脊柱脊髓雜志;2004年09期

10 潘勝發(fā),孫宇,朱振軍,陳景春,劉忠軍,蔡欽林;單開(kāi)門(mén)頸椎管擴(kuò)大椎板成形術(shù)后軸性癥狀與頸椎穩(wěn)定性的相關(guān)觀察[J];中國(guó)脊柱脊髓雜志;2003年10期

，

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