颈椎前路手术治疗平山病初步临床结果

发布时间：2018-01-23 14:48

本文关键词： 平山病颈椎前路手术手术疗效　出处：《中国矫形外科杂志》2017年23期 　论文类型：期刊论文

【摘要】：[目的]探讨平山病患者颈椎前路手术治疗初步效果及平山病的手术缓解机制。[方法]回顾性分析2012年11月~2016年5月接受颈椎前路手术治疗且资料完整的平山病患者13例,所有患者经神经内科确诊,并除外运动神经元疾病,且保守治疗无效,病情持续进展严重影响患者生活质量。其中10例采用颈椎前路单纯钛板螺钉内固定术,3例因存在明显颈椎间盘退变突出,采用颈椎前路ACDF手术治疗。采用改良JOA评分评价术前和末次随访时神经功能,此外,测量患者颈椎后突(C2~7Cobb角),颈椎活动度(ROM)、颈椎最大屈曲角度(MFA)。[结果]所有患者随访7~49个月,平均32.7±15个月。末次随访时,术后伸指震颤症状减轻,但症状未完全消失;肌肉萎缩症状改善不明显。改良JOA评分由术前的(12.85±1.70)增加至末次随访时的(14.38±1.46),差异有统计学意义(P=0.021)。术后屈曲位颈椎MRI可以观察到脊髓前方压迫缓解,并有局部脊髓膨胀表现。术前与末次随访时相比较,C2~7Cobb角[(10.69±11.12)°vs(8.08±8.14)°,P=0.50]差异无统计学意义;但颈椎活动度[(71.92±15.65)°vs(37.69±11.18)°,P0.001]和颈椎最大屈曲角度[(37.08±6.80)°vs(20.15±8.65),P0.001]显著减少,差异有统计学意义。[结论]颈椎前路内固定或融合手术能够限制平山病患者颈椎过度前屈,从而减少颈椎活动时脊髓前侧的反复撞击,减缓甚至停止上肢远端肌萎缩的进展。
[Abstract]:[Objective] to investigate the primary effect of anterior cervical surgery in patients with Pingshan disease and the mechanism of surgical relief. [Methods: from November 2012 to May 2016, 13 patients with Pingshan disease underwent anterior cervical surgery and complete data were analyzed retrospectively. All patients were diagnosed by neurology. Besides motor neuron disease, the conservative treatment was ineffective, and the continuous progress of the disease seriously affected the quality of life of the patients. Among them, 10 cases were treated with anterior cervical anterior titanium plate screw fixation. 3 cases were treated by anterior cervical ACDF operation because of obvious cervical disc herniation. The nerve function was evaluated by modified JOA score before operation and at the last follow-up. The posterior cervical process C _ 2 ~ (7) Cobb angle, the cervical motion and the maximum flexion angle of the cervical vertebrae were measured. [Results: all the patients were followed up for 7 to 49 months (mean 32.7 卤15 months). The improved JOA score increased from 12.85 卤1.70 before operation to 14.38 卤1.46 at the last follow-up. The difference was statistically significant (P < 0. 021). The anterior compression and local expansion of spinal cord could be observed by MRI in flexion position. C _ 2o _ 7 Cobb angle. [There was no significant difference in activity of cervical vertebrae between 10. 69 卤11. 12 掳vs(8.08 卤8. 14 掳vs(8.08 卤8. 14 掳. [71.92 卤15.65 掳vs(37.69 卤11.18 掳P0.001] and maximum cervical flexion angle. [37.08 卤6.80 掳vs(20.15 卤8.65 (P0.001) decreased significantly (P 0.001), and the difference was statistically significant. [Conclusion: anterior cervical internal fixation or fusion surgery can limit the overflexion of cervical vertebrae in patients with Pingshan disease, so as to reduce the recurrent impact on the anterior side of the spinal cord and to slow down or even stop the progress of distal muscle atrophy of the upper limb.
【作者单位】：首都医科大学附属北京天坛医院;
【基金】：国家自然科学基金资助项目(编号:81472137) 北京市自然科学基金资助项目(编号:7162058) 北京市卫生系统高层次卫生技术人才资助项目(2014-3-034)
【分类号】：R687.3
【正文快照】： 平山病[1-2](Hirayama disease,HD)最早由日本学者平山惠造在1959年报道,是一种以一侧手肌肉或双侧手肌肉萎缩,逐渐出现前臂尺侧肌肉的神经源性肌萎缩疾病,又称青少年上肢远端肌萎缩症(juve-nile muscular atrophy of distal upper extremity),或者单肢肌萎缩病(monomelic amy

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