平山病外科治疗的中期临床效果及影像学结果

发布时间：2018-01-19 02:30

本文关键词： 平山病内固定融合术疗效影像学　出处：《北京大学学报(医学版)》2017年06期 　论文类型：期刊论文

【摘要】：目的:回顾性分析应用颈前路融合内固定术治疗平山病的中期临床及影像学结果,探讨外科治疗的意义和价值。方法:36例平山病患者采用颈椎前路融合钛板内固定术治疗,观察术后3个月、1年、2年时肌肉萎缩和肌力变化,测量术后C2-7颈椎活动度的改变及C4-7节段中立位颈椎MRI横断面脊髓面积的改变。结果:(1)临床结果:除1例患者外,所有患者术后肌肉萎缩和肌无力无继续进展。随着时间推移,自觉肌无力改善的患者比例逐年增高:术后3个月为26.5%,术后1年为36.0%,术后2年时有85.7%的患者感觉肌力增加;同时肌萎缩改善的患者比例也逐年增高:术后3个月为8.8%,术后1年为24.0%,术后2年时有35.8%的患者感觉肌萎缩好转。截至术后2年随访时段时,14例患者中有12例受累肌力改善,5例肌肉萎缩得到不同程度改善。(2)影像学结果:C2-7颈椎活动度术后较术前显著减小,由术前平均62.25°±2.10°减少为术后2年时平均13.67°±7.51°(P0.01)。屈曲位MRI脊髓不再受到压迫。颈椎各个节段MR横断面积:术后3个月时仅C6一个节段的面积较术前增大(P0.05);术后1年时C4-5-6三个节段面积均较术前增大(均为P0.01);术后2年时C4-5-6-7四个节段面积均较术前增大,其中C4脊髓面积增大15.60%、C5增大19.08%、C6增大21.60%、C7增大23.91%,与术前相比差异均具有统计学意义(P0.05)。结论:前路内固定植骨融合术是治疗平山病的有效方法,可以获得较好的中期临床转归和影像学结果,对于控制平山病的发展和转归有着积极的意义和价值。
[Abstract]:Objective: to retrospectively analyze the mid-term clinical and imaging results of anterior cervical fusion and internal fixation in the treatment of Pingshan disease. Methods 36 patients with Pingshan disease were treated with anterior cervical fusion titanium plate fixation. The changes of muscle atrophy and muscle strength were observed at 3 months, 1 year and 2 years after operation. The changes of C2-7 cervical motion and the area of cervical MRI cross-sectional spinal cord in the neutral position of C4-7 were measured. Results the clinical results were as follows: except for one patient. With the passage of time, the proportion of patients with conscious myasthenia improved year by year: 26.5% in 3 months after operation and 36.0% in 1 year after operation. At 2 years after operation, 85.7% of the patients had increased sensory muscle strength. At the same time, the proportion of patients with improved muscular atrophy increased year by year: 8. 8 in 3 months after operation, and 24.0% in 1 year after operation. Sensory muscle atrophy was improved in 35.8% of the patients 2 years after operation, and 12 of 14 patients had improved muscle strength by the end of 2 years follow-up. The imaging results of 5 cases of muscular atrophy were significantly decreased after the operation of the cervical vertebrae motion of 1% C2-7 compared with that before operation. The mean value decreased from 62.25 掳卤2.10 掳before operation to 13.67 掳卤7.51 掳P0.01 at 2 years after operation. In flexion position, the spinal cord of MRI was no longer compressed. The transverse area of Mr of each segment of cervical spine: at 3 months after operation, the area of only one segment of C6 was increased compared with that of preoperation (P0.05). At 1 year after operation, the area of three segments of C4-5-6 was increased compared with that of preoperation (P 0.01). At 2 years after operation, the four segments of C4-5-6-7 increased, and the area of C4 spinal cord increased 15.60% and 19.08% and C6 increased 21.60% respectively. C7 increased 23.91, compared with the preoperative differences were statistically significant (P 0.05). Conclusion: anterior internal fixation fusion is an effective method for the treatment of Pingshan disease. It can obtain better clinical outcome and imaging results in the medium term, and has positive significance and value for controlling the development and outcome of Pingshan disease.
【作者单位】：北京大学第三医院骨科;北京大学国际医院骨科;北京大学第三医院神经内科;
【分类号】：R687.3
【正文快照】： 内科,北京100191)△Corresponding author’s e-mail,sunyuor@vip.sina.com网络出版时间:2017-10-19 10:11:10网络出版地址:http://www.cnki.net/kcms/detail/11.4691.R.20171019.1011.008.html平山病(Hirayama disease,HD),又称青少年上肢远端肌萎缩症(juvenile muscular atr

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