不同颈椎后路单开门椎管扩大成形术术后相关效对比分析

发布时间：2018-01-16 18:28

本文关键词：不同颈椎后路单开门椎管扩大成形术术后相关效对比分析　出处：《山西医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:对不同颈椎后路单开门椎管扩大成形术术后的疗效及术后相关并发症进行对比分析,并对其原因进行探讨。方法:回顾性分析我院从2009年5月至2012年6月采用颈椎后路单开门椎管扩大成形术治疗的脊髓型颈椎病患者181例,根据开门后固定方式不同,分为钛板固定组与悬吊固定组(包括丝线悬吊固定组与锚钉悬吊固定组)。钛板固定组96例;悬吊固定组85例,其中丝线悬吊固定组46例,锚钉悬吊固定组39例。对钛板固定组与悬吊固定组做组间对比,并对传统悬吊固定组做组内对比。对比内容包括JOA评分、手术时间、出血量、脊髓致压程度(a/M)、颈椎总活动度(ROM)、开门角度、脊髓后移距离及术后并发症等。结果:181例患者均获得随访,随访时间都在2年以上。丝线悬吊固定组与锚钉悬吊固定组对比,两组患者术前一般情况、手术时间、术中出血量、术后2年JOA评分改善率、术后颈椎总活动度丢失量、门轴侧融合率及术后相关并发症对比,差异均无统计学意义。钛板固定组与悬吊固定组对比,术前一般情况、手术时间、术中出血量、术前及术后2年JOA评分、JOA评分改善率、脊髓后移距离、脊髓致压程度(a/M)对比,差异均无统计学意义;钛板固定组6例发生C5神经根麻痹,悬吊固定组4例,两组对比差异无统计学意义;术后3个月与6个月门轴侧融合率,钛板固定组均高于悬吊固定组,差异有统计学意义;术后6个月再关门发生率、颈椎总活动度丢失量、轴性症状发生率对比,悬吊固定组均明显高于钛板固定组,差异有统计学意义。结论:采用微型钛板做开门侧固定,可以达到充分脊髓减压,获得满意神经功能改善率,同时,与传统悬吊固定相比,采用微型钛板固定更有利于门轴侧骨性愈合,防止再关门现象的发生,也可明显减少术后颈椎活动度的丢失,降低轴性症状的发生率,临床疗效肯定。
[Abstract]:Objective: to compare the curative effect and postoperative complications of different posterior cervical open door laminoplasty. Methods: from May 2009 to June 2012, 181 patients with cervical Spondylotic myelopathy were treated with open door laminoplasty. According to the different fixation methods after opening door, they were divided into titanium plate fixation group and suspension fixation group (including wire suspension fixation group and anchor nail suspension fixation group, 96 cases of titanium plate fixation group; There were 85 cases in the suspension fixation group, 46 cases in the silk thread group and 39 cases in the anchor nail group. The comparison between the titanium plate fixation group and the suspension fixation group was made. The comparison included JOA score, operative time, bleeding volume, spinal cord compression degree, total motion of cervical spine, open door angle. Results 181 patients were followed up for more than 2 years. The time of operation, the amount of intraoperative bleeding, the improvement rate of JOA score 2 years after operation, the loss of total cervical movement after operation, the rate of portal-axial fusion and the postoperative complications were compared. There was no significant difference between the titanium plate fixation group and the suspension fixation group, the average preoperative condition, operation time, intraoperative bleeding volume, JOA score before and 2 years after operation were improved. There was no significant difference in the distance of spinal cord backward and the degree of spinal cord compression (A / M). There were 6 cases of C5 nerve root paralysis in titanium plate fixation group and 4 cases in suspension fixation group. There was no significant difference between the two groups. The rate of portal axial fusion at 3 and 6 months after operation was higher in the titanium plate fixation group than in the suspension fixation group, and the difference was statistically significant. Six months after operation, the incidence of reclosing, the loss of total cervical movement and the incidence of axial symptoms were significantly higher in the suspension fixation group than in the titanium plate fixation group. Conclusion: the decompression of spinal cord and satisfactory improvement rate of nerve function can be achieved by using mini-titanium plate to fix the open door side of the spinal cord. At the same time, compared with the traditional suspension fixation. The microplate fixation is more beneficial to the healing of hilar axial bone, prevents the phenomenon of reclosing, and can obviously reduce the loss of cervical movement and the incidence of axial symptoms after operation. The clinical effect is positive.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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