膨胀螺钉系统用于ACDF术后临床与影像学观察

发布时间：2018-02-10 10:59

本文关键词： 颈椎前路减压膨胀螺钉植骨融合内植物并发症　出处：《吉林大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:对膨胀螺钉系统应用于颈椎前路减压植骨融合内固定术后的中期临床和影像学观察和分析。材料和方法:21例颈椎术后患者纳入该研究。男性14例,女性7例;年龄最小19岁,最大61岁,平均43.58岁;13例外伤所致,8例为颈椎间盘突出症。减压范围:单一节段者8例,两个节段者13例。患者均接受颈椎前路膨胀螺钉系统行颈椎前路椎间隙减压植骨融合内固定术。术后患者随访时间从3个月到2年,平均9.7个月。术前和术后定期随访拍摄颈椎正侧位和CT,观测临床疗效,椎间高度,颈椎前凸曲度,内植物融合情况,手术时间及出血量等手术情况。临床疗效通过JOA评分评定。应用Excel进行数据整理,采用SPSS20.0软件进行分析;患者术前、术后及末次随访时的颈椎曲度、椎间隙高度、JOA评分对比采用配伍组设计资料的方差分析方法,两两比较采用LSD法,以P0.05为差异有统计学意义。结果:21例患者平均手术时间52.48min,平均出血量31.12ml。随访时间3个月到2年,平均9.7个月。术后JOA评分明显提高(术前7.42±0.18,术后13.19±0.18,末次随访时14.24±0.18)。术前术后和末次随访时均有统计学意义。对患者颈椎曲度的测量(术前15.59±1.88、术后18.74±2.32、末次随访时16.63±1.73)差异有统计学意义(P0.001);采用LSD法进行两两比较,患者术前与术后的颈椎曲度差异有统计学意义(P0.001),术前与末次随访时的颈椎曲度差异有统计学意义(P0.007),术后与末次随访时的颈椎曲度差异有统计学意义(P0.002)。患者椎间隙高度(术前6.31±1.56、术后8.78±1.90、末次随访时7.59±1.70)差异有统计学意义(P0.001);采用LSD法进行两两比较,患者术前与术后的椎间隙高度差异有统计学意义(P0.001),术前与末次随访时的椎间隙高度差异有统计学意义(P0.001),术后与末次随访时的椎间隙高度差异有统计学意义(P0.001)。所有患者术后内固定融合率均为100%。至末次随访时,无一例内植物并发症。结论:1.膨胀螺钉系统用于ACDF病例中,术后和末次随访时JOA评分均高于术前,且末次随访和术后相比,改善率提高明显;2.该系统维持术后颈椎生理曲度满意,保持了颈椎生物力学稳定性;3.维持良好的椎间隙高度,为植骨块与上下椎体间融合提供条件;4.术后12个月随访表明所有患者植骨均获得骨性融合。
[Abstract]:Objective: to observe and analyze the clinical and imaging features of dilated screw system after anterior decompression, fusion and internal fixation. Materials and methods 21 cases of cervical vertebrae operation were included in the study, 14 males and 7 females; The age was 19 years old, the oldest was 61 years old, the average age was 43.58 years old, 13 cases were caused by cervical disc herniation. There were 13 cases with two segments. All patients were treated with anterior cervical vertebrae intervertebral space decompression and bone grafting and internal fixation. The follow-up period was from 3 months to 2 years. The mean time was 9.7 months. The anterior and lateral cervical vertebrae and CTS were recorded before and after operation, and the clinical efficacy, intervertebral height, curvature of cervical spine protruding and fusion of internal plants were observed. The clinical efficacy was evaluated by JOA score. The data were collected by Excel and analyzed by SPSS20.0 software. The cervical curvature of patients before, after operation and at the last follow-up was evaluated. The analysis of variance (ANOVA) method was used to evaluate the height of intervertebral space and the LSD method was used to compare the data of the matched group. Results the mean operation time was 52.48 minutes, and the average bleeding was 31.12 ml. The follow-up time was 3 months to 2 years. The JOA score increased significantly after operation (preoperative 7.42 卤0.18, postoperative 13.19 卤0.18, last follow-up 14.24 卤0.18). There was a significant difference in cervical curvature between preoperative and last follow-up (15.59 卤1.88, 18.74 卤2.32, 16.63 卤1.73, respectively). The difference was statistically significant (P 0.001). The results were compared by using LSD method. There was significant difference between preoperative and postoperative cervical curvature (P 0.001), between preoperative and last follow-up (P 0.007), and between postoperative and last follow-up (P 0.002). The difference of height (preoperative 6.31 卤1.56, postoperative 8.78 卤1.90, last follow-up 7.59 卤1.70) was statistically significant (P 0.001). There was significant difference between preoperative and postoperative intervertebral space height (P 0.001), between preoperative and last follow-up (P 0.001), and between postoperation and last follow-up (P 0.001). The internal fixation fusion rate of all patients was 100 and 100%. No intra plant complications were found. Conclusion 1. The JOA score of ACDF patients after and at the last follow-up was higher than that in the last follow-up, and was higher in the last follow-up than that in the postoperatively. The improvement rate was significantly improved 2.The system maintained satisfactory physiological curvature of cervical spine after operation, maintained the biomechanical stability of cervical vertebrae and maintained a good height of intervertebral space. All the patients were followed up 12 months after operation and showed that bone fusion was achieved in all patients.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

【参考文献】