单节段颈前路椎间盘切除减压固定植骨融合术椎间隙高度恢复程度对临床疗效的影响
发布时间：2018-11-13 17:30
【摘要】：目的:对ACDF(颈椎前路椎间盘切除减压内固定植骨融合术)这一手术方式治疗单节段颈椎退变性疾病(Cervical degenerative disc disease,CDDD)过程中,椎间隙高度恢复程度对临床疗效的影响进行探讨,从而为术者在行颈前路手术中选择合适的椎间隙撑开高度提供参考和评价。方法:回顾性分析了从2012年1月至2014年12月于大连医科大学附属第一医院的150例行因CDDD行单节段ACDF的患者,男性和女性分别为95例、55例,病人年龄范围为51岁～83岁,年龄的平均值为(65.39±9.59)岁。累及部位:C3/4 9例C4/5 30例C5/6 96例C6/7 15例。根据手术中椎间隙高度恢复程度占基准高度的百分率分为A组(术后即刻椎间高度/目标椎间隙基准高度位于100-120%)28例;B组(术后即刻椎间高度/目标椎间隙基准高度位于120-140%)63例;C组(术后即刻椎间高度/目标椎间隙基准高度位于140-160%)59例。经比较:不同组别病人一般信息、手术部位分布无显著差异,可比性较好。通过对不同分组手术前后及末次随访等不同时期神经功能缓解情况、颈椎轴性症状发生率、目标椎间隙高度变化、相邻节段退变情况等指标的比较,分析不同椎间隙高度恢复程度对临床疗效的影响。结果:1.三组患者年龄、性别经两两组间独立样本检验分析,P0.05,无统计学意义,即三组患者的年龄分布无差别,说明三组具有可比性。2.三组术前J0A分析结果显示三组无统计学差异,F=924,p=0.399,大于0.05。术后三组的J0A评分均有明显的提高,均较术前差异有统计学意义。神经功能恢复率:B组71.88%优于C组68.62%优于A组42.25%,120-140%椎间隙高度神经恢复率最佳。3.颈椎轴性症状三组患者颈前路融合术后2年,颈椎轴性症状的发生率分别为35.71%、15.87%和42.37%。三组患者的术后2年轴性症状发病率A组和C组的发生率均高于B组,均存在统计学差异。B组120-140%椎间隙高度是最理想选择。4.术后即刻椎间隙高度,B组C组恢复高度大于A组,而B组C组之间无统计学差异。至末次随访椎间隙高度丢失,C组高度丢失最大,与A组B组有统计学差异。5.在平均2年随访时,相邻椎间隙丢失高度量,B组丢失量最小,分别比较A组、C组,P小于0.05,均存在统计学差异。A组、C组比较无统计学差异。结论:本课题通过临床回顾性研究发现,椎间隙恢复高度达基准高度100-160%时,2年随访期内均未出现脊髓过度牵拉等严重并发症,均较术前取得良好疗效。其中以120-160%基准高度为较理想高度,J0A神经功能取得更好的恢复。又考虑术后颈椎轴性症状、随访目标椎间隙高度丢失、相邻椎间隙高度丢失,以120-140%基准高度最佳,推荐ACDF椎间隙恢复高度达到基准高度120-140%。
[Abstract]:Objective: to treat single segment cervical degenerative disease (Cervical degenerative disc disease,CDDD) with ACDF (anterior cervical disc resection, decompression, internal fixation and fusion). The effect of the recovery degree of intervertebral space height on clinical curative effect was discussed, so as to provide a reference and evaluation for the choice of appropriate intervertebral space open height in anterior cervical surgery. Methods: from January 2012 to December 2014, one hundred and fifty patients (95 male and 55 female) with single segment ACDF received CDDD in the first affiliated Hospital of Dalian Medical University were analyzed retrospectively. The age of the patients ranged from 51 to 83 years. The average age was (65.39 卤9.59) years old. Site of involvement: C 3 / 49, C 4 / 5, C 5 / 6, C 6 / 6, C 6 / 7, 15 cases. According to the percentage of the recovery degree of intervertebral space height to the reference height during the operation, 28 cases were divided into group A (immediate postoperative intervertebral height / target intervertebral space standard height was 100-120%). There were 63 cases in group B (120-140%) and 59 cases in group C (140-160%). Comparison showed that there was no significant difference in the distribution of surgical site in different groups of patients. The neurologic function relief, the incidence of cervical axial symptoms, the change of height of the target intervertebral space, and the degeneration of adjacent segments were compared before and after different group operations and at the last follow-up. To analyze the effect of different intervertebral space height recovery on clinical efficacy. The result is 1: 1. The age and sex of the three groups were analyzed by independent sample test between two groups, P0.05, there was no statistical significance, that is, there was no difference in age distribution among the three groups, indicating that the three groups were comparable. 2. The results of J0A analysis before operation showed that there was no statistical difference among the three groups. The scores of J 0A in the three groups were significantly improved after operation, and the differences were statistically significant compared with those before operation. The recovery rate of nerve function in group B was 71.88% higher than that in group C (68.62%), which was better than that in group A (42.25% -120-140%). The incidence of cervical axial symptoms in the three groups was 35.71% and 42.37% respectively 2 years after anterior cervical fusion. The incidence of axial symptoms in group A and group C was higher than that in group B. the height of intervertebral space between 120% and 140% in group B was the best choice. The height of intervertebral space in group B was higher than that in group A immediately after operation, but there was no significant difference between group B and C. To the last follow-up, the height loss of intervertebral space in group C was the largest, which was significantly different from that in group A and group B. At the mean follow-up of 2 years, the loss of the height of adjacent intervertebral space was the least in group B, and there was statistical difference between group A and group C (P < 0.05), but there was no statistical difference between group A and group C. Conclusion: through clinical retrospective study, we found that there were no severe complications such as excessive spinal cord traction in the 2-year follow-up period when the height of vertebral space recovered to 100-160% of the standard height, which was better than that before operation. With 120-160% datum height as the ideal height, the nerve function of J0A recovered better. Considering the axial symptoms of cervical spine after operation, the height loss of target intervertebral space and adjacent intervertebral space were followed up. The best standard height was 120-140%. It was recommended that the recovery height of ACDF intervertebral space be 120-140%.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
，
本文编号：2329862
[Abstract]:Objective: to treat single segment cervical degenerative disease (Cervical degenerative disc disease,CDDD) with ACDF (anterior cervical disc resection, decompression, internal fixation and fusion). The effect of the recovery degree of intervertebral space height on clinical curative effect was discussed, so as to provide a reference and evaluation for the choice of appropriate intervertebral space open height in anterior cervical surgery. Methods: from January 2012 to December 2014, one hundred and fifty patients (95 male and 55 female) with single segment ACDF received CDDD in the first affiliated Hospital of Dalian Medical University were analyzed retrospectively. The age of the patients ranged from 51 to 83 years. The average age was (65.39 卤9.59) years old. Site of involvement: C 3 / 49, C 4 / 5, C 5 / 6, C 6 / 6, C 6 / 7, 15 cases. According to the percentage of the recovery degree of intervertebral space height to the reference height during the operation, 28 cases were divided into group A (immediate postoperative intervertebral height / target intervertebral space standard height was 100-120%). There were 63 cases in group B (120-140%) and 59 cases in group C (140-160%). Comparison showed that there was no significant difference in the distribution of surgical site in different groups of patients. The neurologic function relief, the incidence of cervical axial symptoms, the change of height of the target intervertebral space, and the degeneration of adjacent segments were compared before and after different group operations and at the last follow-up. To analyze the effect of different intervertebral space height recovery on clinical efficacy. The result is 1: 1. The age and sex of the three groups were analyzed by independent sample test between two groups, P0.05, there was no statistical significance, that is, there was no difference in age distribution among the three groups, indicating that the three groups were comparable. 2. The results of J0A analysis before operation showed that there was no statistical difference among the three groups. The scores of J 0A in the three groups were significantly improved after operation, and the differences were statistically significant compared with those before operation. The recovery rate of nerve function in group B was 71.88% higher than that in group C (68.62%), which was better than that in group A (42.25% -120-140%). The incidence of cervical axial symptoms in the three groups was 35.71% and 42.37% respectively 2 years after anterior cervical fusion. The incidence of axial symptoms in group A and group C was higher than that in group B. the height of intervertebral space between 120% and 140% in group B was the best choice. The height of intervertebral space in group B was higher than that in group A immediately after operation, but there was no significant difference between group B and C. To the last follow-up, the height loss of intervertebral space in group C was the largest, which was significantly different from that in group A and group B. At the mean follow-up of 2 years, the loss of the height of adjacent intervertebral space was the least in group B, and there was statistical difference between group A and group C (P < 0.05), but there was no statistical difference between group A and group C. Conclusion: through clinical retrospective study, we found that there were no severe complications such as excessive spinal cord traction in the 2-year follow-up period when the height of vertebral space recovered to 100-160% of the standard height, which was better than that before operation. With 120-160% datum height as the ideal height, the nerve function of J0A recovered better. Considering the axial symptoms of cervical spine after operation, the height loss of target intervertebral space and adjacent intervertebral space were followed up. The best standard height was 120-140%. It was recommended that the recovery height of ACDF intervertebral space be 120-140%.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
，
本文编号：2329862
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