【摘要】：目的:探討在ACDF治療多節(jié)段頸椎病中應(yīng)用限制性鋼板與非限制性鋼板對手術(shù)后頸椎曲度弧度丟失率的比較方法:收集2011年2月至2013年12月在我科行頸前路椎間隙減壓手術(shù)治療的多節(jié)段頸椎病患者67例。其中男38例,女29例,年齡41-69歲,平均年齡51歲。隨機(jī)分成A、B兩組,A組兩節(jié)段的29例,三節(jié)段的6例;術(shù)中使用限制性鋼板,B組兩節(jié)段的25例,三節(jié)段的8例,術(shù)中使用非限制性鋼板。收集所有患者手術(shù)前、手術(shù)后1個月、半年、1年隨訪的頸椎側(cè)位片及評估JOA評分。所有數(shù)據(jù)采用SPSS19.0軟件進(jìn)行組內(nèi)配對t檢驗及組間χ2檢驗分析,以P0.05定為差異有統(tǒng)計學(xué)意義。結(jié)果:所有患者均獲得完整隨訪資料,所有患者均于術(shù)后3-4天出院,隨訪時間12-18個月,平均14.2個月。兩組患者術(shù)后椎間植骨融合率為100%,所有患者均未出現(xiàn)螺釘脫出,鋼板移位或斷裂現(xiàn)象。兩組患者手術(shù)后神經(jīng)功能較術(shù)前均有明顯改善,A組JOA評分由術(shù)前(8.7±1.4)分提升至(14.7±1.2)分,B組由術(shù)前的(8.6±1.5)分提升至(14.1±1.5)分;術(shù)后1年隨訪JOA改善率:A組為74.43%,B組為68.75%;兩組間各時期JOA評分無明顯統(tǒng)計學(xué)差異。兩組患者手術(shù)后頸椎生理曲度較術(shù)前均有改善,但兩組之間無統(tǒng)計學(xué)差異。A組兩節(jié)段頸椎病患者手術(shù)后1年頸椎生理曲度丟失率為(1.33±0.28)°,三節(jié)段頸椎病患者丟失率為(5.42±1.68)°;B組兩節(jié)段頸椎病患者丟失率為(1.48±0.31)°,三節(jié)段頸椎病患者丟失率(5.53±1.71)°;兩組患者丟失率無明顯統(tǒng)計學(xué)差異,A組頸椎生理曲度丟失率總體均數(shù)稍低于B組。兩組患者手術(shù)后椎間高度較術(shù)前均有改善,A組兩節(jié)段頸椎病患者手術(shù)后1年的椎間高度丟失量為(1.81±0.47)mm,三節(jié)段患者丟失量為(2.17±0.61)mm;B組兩節(jié)段頸椎病患者丟失量為(2.62±0.46)mm,三節(jié)段患者丟失量為(2.93±0.37)mm;兩組患者椎間高度丟失量在統(tǒng)計上無明顯差異,但A組椎間高度總體丟失量均數(shù)低于B組。A組術(shù)后頸部軸性癥狀發(fā)生率為5.07%,B組的發(fā)生率為12.50%;兩組頸部軸性癥狀發(fā)生率無統(tǒng)計學(xué)差異,A組頸部軸性癥狀發(fā)生率總體低于B組。結(jié)論:1.ACDF在治療多節(jié)段頸椎病患者時,結(jié)合限制性鋼板或非限制性鋼板均可獲得滿意的臨床療效。2.在術(shù)后維持頸椎生理曲度、椎間高度及減少頸部軸性癥狀發(fā)生率方面限制性鋼板稍優(yōu)于非限制性鋼板。
[Abstract]:Objective: to investigate the comparison of the loss rate of curvature of cervical spine with restriction plate and unconstrained plate in the treatment of multilevel cervical spondylosis by ACDF: to collect the anterior cervical intervertebral space from February 2011 to December 2013 in our department. 67 patients with multilevel cervical spondylosis treated by decompression surgery. There were 38 males and 29 females, aged 41-69 years, with an average age of 51 years. They were randomly divided into two groups: 29 cases in group A, 6 cases in three segments, 25 cases in group B, 25 cases in group B and 8 cases in three segments. All patients were followed up for 1 month, 1 month, 6 months and 1 year after operation and JOA score was evaluated. All data were analyzed by intra-group paired t-test and 蠂 ~ 2 test with SPSS19.0 software. Results: all the patients received complete follow-up data. All patients were discharged from hospital 3-4 days after operation for 12-18 months with an average of 14. 2 months. The fusion rate of intervertebral bone graft was 100% in both groups. No screw protrusion, plate displacement or fracture were found in all the patients. The neurological function in group A was improved from (8.7 鹵1. 4) to (14. 7 鹵1. 2) in group A and from (8.6 鹵1. 5) in group B to (14. 1 鹵1. 5) in group B. The improvement rate of JOA in group A was 74.43 and that in group B was 68.750.There was no significant difference in JOA score between the two groups. There was no statistical difference between the two groups. The loss rate of physiological curvature of cervical spine in group A was (1.33 鹵0.28) 擄1 year after operation. The loss rate of patients with three-segment cervical spondylosis was (5.42 鹵1.68) 擄. In group B, the loss rate was (1.48 鹵0.31) 擄in patients with two-segment cervical spondylosis and (5.53 鹵1.71) 擄in patients with three-segment cervical spondylosis. There was no significant difference in the loss rate between the two groups, and the total mean loss rate of cervical vertebra physiological curvature in group A was slightly lower than that in group B. The loss of intervertebral height in group A was (1. 81 鹵0. 47) mm, and (2. 17 鹵0. 61) mm;. The loss of two segments of cervical spondylopathy in group B was (2.62 鹵0.46) mm, and the amount of loss in three-segment patients was (2.93 鹵0.37) mm;. There was no statistical difference in the loss of intervertebral height between the two groups, but the average of total loss of intervertebral height in group A was lower than that in group B. the incidence of cervical axial symptoms in group A was 5.07 and 12.50 respectively. The incidence of cervical axial symptoms in group A was lower than that in group B. Conclusion: when 1.ACDF is used in the treatment of multilevel cervical spondylopathy, the combination of restricted plate and unconstrained plate can obtain satisfactory clinical curative effect. 2. The restrictive plate was superior to the unconstrained plate in maintaining the physiological curvature of cervical spine, intervertebral height and reducing the incidence of cervical axial symptoms.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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