显微镜辅助下前路与后-前路融合治疗下颈椎骨折脱位的临床疗效分析

发布时间：2018-01-13 21:16

本文关键词：显微镜辅助下前路与后-前路融合治疗下颈椎骨折脱位的临床疗效分析　出处：《遵义医学院》2016年硕士论文　论文类型：学位论文

【摘要】：目的:通过显微镜下和无显微镜下前路与后-前路融合治疗下颈椎骨折脱位疗效对比,探讨显微镜在下颈椎骨折脱位手术中的优点。方法:回顾性分析2007年1月-2015年1月收治的下颈椎骨折脱位合并脊髓损伤的患者51例。根据手术过程中是否使用显微镜分为两组,其中显微镜组26例,行前路融合内固定12例,行颈后-前路融合内固定14例;无显微镜组25例,行前路融合内固定13例,颈后-前路融合内固定12例;按受伤部位分为:C3:8例,C4:11例,C5:17例,C6:10例,C7:5例。51例患者术后均获得随访,随访13-26个月,平均随访14.2个月,分别比较显微镜和无显微镜的两种术式在手术时间、术中失血量、神经损伤恢复(ASIA分级)、术后改良JOA评分、术后症状改善率、Cobb角等指标的差异,并观察植骨愈合情况及有无并发症发生。运用SPSS20.0软件进行数据分析,P0.05认为差异有显著统计意义。结果:术后随访复查提示所有颈椎脱位均复位良好,均无螺钉或钛板松动、滑脱、断裂,术后12个月随访时植骨均全部融合。显微镜下前路组12例:手术时间为70.4min±7.2min,术中失血量为113.3ml±15.6m1,术后ASIA功能分级均有不同程度的改善,改良JOA评分:术前7.37分±2.35分,术后1周13.34分±2.15分,术后改善率73.27%±18.79%,Cobb角:术前-4.4°±3.2°,术后1周6.8°±3.9°,术后12月6.1°±4.1°;术后无并发症。后-前路组:手术时间为210.6±13.9min,术中失血量为226.6±37.8m1,术后ASIA功能分级均有不同程度的改善,改良JOA评分:术前7.19±1.26分;术后13.38±2.31分,术后改善率73.13%±18.43%;Cobb角:术前-5.2°±3.4°,术后1周6.8°±3.8°,术后12月6.7°±3.6°,术后切口感染1例。无显微镜组前路组13例:手术时间为81.2min±8.0min,术中失血量为158.3ml±20.3m1,术后ASIA功能分级1例无恢复,其余均有不同程度的改善,改良JOA评分:术前7.52分±2.45分,术后1周11.97分±2.18分,术后改善率62.27%±21.77%,Cobb角:术前-4.8°±3.7°,术后1周6.5°±4.1°,术后12月6.6°±4.3°;术后声音嘶哑2例,脑脊液漏2例,后-前路组:手术时间为230.0min±15.0min,术中失血量为316.6ml±61.0m1,术后ASIA功能分级1例无恢复,其余均有不同程度的改善,改良JOA评分:术前7.28±1.26分;术后11.15分±2.79分,术后改善率62.13%±20.00%;Cobb角:术前-5.5°±3.1°,术后1周6.2°±3.9°,术后12月6.1°±3.1°。术后颈前部血肿2例。显微镜下前路组和后-前路组的手术时间、术中出血量明显少于无显微镜组,差异均有统计学意义(P0.05)。显微镜前路组与后-前路组的术后JOA评分及术后改善率优于无显微镜组,差异均有统计学意义(P0.05),而在Cobb角和植骨融合情况方面比较差异无统计学意义(P0.05)。结论:显微镜辅助下前路与后-前路融合治疗下颈椎骨折脱位的临床疗效优于无显微镜手术组,显微镜下手术治疗具有手术时间短、创伤小,出血少,安全性高,减压效果确切等优点。
[Abstract]:Objective: to compare the effect of anterior and posterior anterior fusion in the treatment of fracture and dislocation of lower cervical spine under microscope and without microscope. To explore the advantages of microscope in the operation of fracture and dislocation of lower cervical vertebra. A retrospective analysis of 51 patients with spinal cord injury associated with fracture and dislocation of the lower cervical spine from January 2007 to January 2015 was made. According to whether the microscope was used during the operation, the patients were divided into two groups. Among them, 26 cases in microscope group were treated with anterior fusion and internal fixation, and 14 cases were treated with posterior cervical fusion and anterior fusion internal fixation. In the group without microscope, 13 cases were treated with anterior fusion and 12 cases with anterior cervical fusion. According to the injury site, the patients were divided into 8 cases of C3: 8 cases of C4: 11 cases of C5: 17 cases of C6: 10 cases of C7: 10 cases of C7: 5 cases. 51 cases of patients were followed up for 13-26 months. The average follow-up time was 14.2 months. The operative time, blood loss, nerve injury recovery and improved JOA score were compared between the two types of operation under microscope and without microscope, respectively. The difference of symptom improvement rate and Cobb angle was observed. The union of bone graft and the occurrence of complications were observed. The data were analyzed by SPSS20.0 software. Results: all the cervical dislocation were well reduced and there was no screw or titanium plate loosening, slippage and rupture. All the bone grafts were fused at 12 months after operation. The operation time was 70.4 min 卤7.2 min, and the blood loss was 113.3 ml 卤15.6m1 in the anterior approach group under microscope (70.4 min 卤7.2 min). The improved ASIA score was 7.37 卤2.35 before operation and 13.34 卤2.15 at 1 week after operation. The postoperative improvement rate was 73.27% 卤18.79 and Cobb angle: -4.4 掳卤3.2 掳before operation, 6.8 掳卤3.9 掳at 1 week after operation, 6.1 掳卤4.1 掳on December after operation. There were no postoperative complications. In the posterior anterior approach group, the operative time was 210.6 卤13.9min, and the blood loss during operation was 226.6 卤37.8 ml. The functional grading of ASIA was improved in different degree after operation. The modified JOA score was 7.19 卤1.26 before operation. The postoperative improvement rate was 73.13% 卤18.43 and 13.38 卤2.31; The Cobb angle was -5.2 掳卤3.4 掳before operation, 6.8 掳卤3.8 掳at 1 week after operation and 6.7 掳卤3.6 掳on December. The operative time was 81.2 min 卤8.0 min, and the blood loss during operation was 158.3 ml 卤20.3 ml. There was no recovery of ASIA functional grading in 1 case after operation. The other cases were improved in varying degrees. The modified JOA score was 7.52 卤2.45 before operation and 11.97 卤2.18 at 1 week after operation. The postoperative improvement rate was 62.27% 卤21.77% and Cobb angle was 4.8 掳卤3.7 掳before operation, 6.5 掳卤4.1 掳at 1 week after operation and 6.6 掳卤4.3 掳on December after operation. Postoperative hoarseness occurred in 2 cases, cerebrospinal fluid leakage in 2 cases. In the posterior anterior approach group, the operative time was 230.0min 卤15.0min, and the blood loss during operation was 316.6 ml 卤61.0 ml. There was no recovery in 1 case of ASIA functional grading after operation, and the others were improved to some extent. The modified JOA score was 7.28 卤1.26 before operation. The postoperative improvement rate was 62.13% 卤20.00 and 11.15 卤2.79; The Cobb angle was 5.5 掳卤3.1 掳before operation and 6.2 掳卤3.9 掳at 1 week after operation. On December, 6. 1 掳卤3. 1 掳. There were 2 cases of postoperative anterior cervical hematoma. The operative time of the anterior approach group and the posterior anterior approach group was significantly less than that of the no microscope group. The difference was statistically significant (P 0.05). The JOA score and the postoperative improvement rate of the anterior microscope group and the posterior anterior approach group were better than those of the no microscope group, and the difference was statistically significant (P 0.05). There was no significant difference in Cobb angle and bone graft fusion (P0.05). Conclusion: the clinical effect of microscopically assisted anterior and posterior anterior fusion in the treatment of fracture and dislocation of lower cervical spine is better than that in the group without microscope. The surgical treatment under microscope has the advantages of short operation time, less trauma, less bleeding, high safety, accurate decompression effect and so on.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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