颈人工间盘置换术与前入路融合术治疗双节段颈椎病的对照研究

发布时间：2018-01-22 01:21

本文关键词： 前入路颈椎融合手术颈人工间盘颈椎退行性疾患临床疗效研究邻近节段退变　出处：《山东大学》2017年硕士论文　论文类型：学位论文

【摘要】：研究目的:观察与比较颈人工间盘置换术(cervical total disc replacement,cTDR)与前入路融合术(anterior cervical discectomy and fusion,ACDF)治疗连续双节段颈椎病的临床效果。研究方法:回顾性分析2013年7月至2015年7月在我院行连续双节段颈人工间盘置换术(置换组,17例)或前入路颈椎间盘切除减压融合术(融合组,29例)的46例患者,两组患者平均随访时间均为24个月。我们记录并比较了两组患者的一般资料和围手术期情况,并在术前、术后共计6个时间点对纳入者进行日本骨科协会评分(JOA评分)、颈椎残障功能指数(NDI指数)、上肢疼痛视觉模拟评分(VAS评分)测定及Odom手术满意度评分;在上述6个时间点对患者检查颈椎X线检查,观察两组患者术后内植物位置和颈椎活动度的变化,评估有无邻近节段退变等。研究结果:在围手术期指标及并发症方面,置换(cTDR)组与融合(ACDF)组无显著差异(P0.05)。在临床评价指标方面,两组患者进行组内比较:JOA评分、NDI指数及上肢VAS评分均较术前有显著改善(P0.05),两组患者术后神经功能均得到明显恢复;两组患者进行组间比较:术后3月时置换组JOA评分明显优于融合组(P0.05),术后3个月、6个月、12个月、24个月时,置换组NDI指数均优于融合组(P0.05)。在影像学方面,两组患者进行组内比较:末次随访时cTDR组下段颈椎活动度及邻近节段活动度与术前无差异(P0.05),ACDF组下段颈椎活动度较术前丢失、邻近节段活动度较术前增加(P0.05);两组患者进行组间比较:末次随访时两组手术邻近节段的退变无统计学差异(P0.05)。结论:颈人工间盘置换术与前入路融合术在治疗连续双节段颈椎病均有确切的治疗效果,邻椎病的发生概率无显著差异。但是颈人工间盘置换术与前入路融合术相比,有着更好的中短期治疗效果,同时术后可以保留手术节段及下颈椎的活动度,避免相邻节段活动度的代偿性增加。
[Abstract]:Objective: to observe and compare the cervical total disc replacement. CTDR and anterior cervical discectomy and fusion. The clinical effect of continuous double-segment cervical spondylopathy treated with ACDF. Methods: from July 2013 to July 2015, we performed continuous double-segment cervical intervertebral disc replacement in our hospital (replacement group). 17 patients or 46 patients with anterior cervical intervertebral disc resection and decompression and fusion (fusion group 29 cases). The average follow-up time of the two groups was 24 months. We recorded and compared the general data and perioperative data of the two groups before operation. The Japanese Orthopaedic Association (JOA) score and cervical disability function index (NDI) were evaluated at a total of 6 time points after operation. The visual analogue score (VAS) of upper limb pain and the satisfaction score of Odom operation were measured. X-ray examination of cervical vertebrae was performed at the above 6 time points to observe the changes of the position of the internal plants and the motion of the cervical vertebrae in the two groups. To evaluate the presence of adjacent segmental degeneration. Results: perioperative parameters and complications. There was no significant difference between the replacement cTDR group and the fusion ACDF group (P 0.05). The NDI index and upper limb VAS score were significantly improved compared with those before operation (P 0.05). The neurological function of the two groups recovered significantly after operation. Comparison between the two groups: the JOA score in the replacement group was significantly better than that in the fusion group on March, 3 months, 6 months, 12 months and 24 months after operation. The NDI index in the replacement group was better than that in the fusion group (P 0.05). Two groups of patients were compared: at the last follow-up, there was no difference between lower cervical motion and adjacent motion in cTDR group and the loss of lower cervical motion in P0.05ACDF group. The activity of adjacent segment was higher than that of preoperation (P 0.05). Comparison between the two groups: at the last follow-up, there was no significant difference in the degeneration of adjacent segments between the two groups (P 0.05). Conclusion: cervical artificial disc replacement and anterior approach fusion are effective in the treatment of continuous double cervical spondylosis. There was no significant difference in the probability of occurrence of adjacent vertebrae, but the cervical prosthetic disc replacement had better short and medium term therapeutic effect than anterior approach fusion, and the mobility of the surgical segment and lower cervical vertebrae could be preserved after operation. Avoid compensatory increases in the activity of adjacent segments.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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