颈椎过伸性损伤预后相关因素的临床研究

发布时间：2018-02-10 11:33

  本文关键词： 脊髓损伤 颈椎过伸伤 预后 影像学 相关因素 手术　出处：《扬州大学》2017年硕士论文　论文类型：学位论文

【摘要】：颈椎过伸性损伤是一种常见的颈部脊髓损伤,有报导称该类损伤占颈椎各类损伤的35%,本院统计表明该比率高达59.7%,通常有较轻微或隐匿性的骨损伤,当无明显骨性组织损伤或脱位时,常引起漏诊。从而通过对颈椎过伸性损伤患者预后的相关因素进行分析归纳具有重要的临床意义。本研究在收集、整理扬州市第一人民医院近3年来颈椎过伸性损伤患者临床资料的基础上,分析影响颈椎过伸性损伤预后的相关因素,并结合X线、CT、MRI等影像检查手段,分析颈椎过伸性损伤合并椎管狭窄的患者行手术治疗后其预后的疗效分析。研究目的1、本研究通过回顾性分析我院临床相关数据资料,对近3年来我院颈椎过伸性损伤的临床资料进行归纳总结,探讨不同的预后因素。2、回顾性分析2013年-2016年来我院就诊的17例颈椎过伸性损伤行手术治疗的患者病例及影像学资料,探讨颈椎过伸性损伤患者行手术治疗的预后因素。材料与方法对扬州市第一人民医院骨科2013年一 2016年来我院就诊的颈椎过伸性损伤患者的住院病历进行收集,共78例,分别从性别、年龄受伤机制等可能影响预后相关因素,根据患者术前症状、体征进行入院ASIA评分,出院前进行ASIA评分,计算得出好转率。通过Spss17.0软件使用卡方检验和方差分析研究性别、年龄、脊髓损伤程度、伤前有无基础病变、治疗方式、早期改善情况是否存在差异。研究结果1、扬州市第一人民医院骨科2013年-2016年,收治的颈椎过伸性损伤患者共78例,共收集颈椎过伸伤病例78例,其中男性患者60例,女性患者18例。好转率分别为55%,50%。患者多集中在中老年患者,其中51~60岁及71~80岁患者最多。好转率分别为76.5%,41.2%。患者的受伤方式主要有车祸伤、跌倒、撞伤、打架及其他原因导致,主要集中在车祸伤(31例)和不慎跌倒(19例),两者占总研究人数的64.1%。其中好转率分别为51.6%,57.9%。患者入院后大部分病人行保守治疗或转院治疗,患者行手术治疗(17例)后,仅1例无明显好转,其余患者均有好转。手术治疗与非手术治疗两者的好转率94.1%和41.7%。患者有基础病变(51例)多集中在中老年患者,治疗好转人数为21例,无基础疾病患者(27例)治疗后有20例出现好转。两者的好转率分别为41.2%和74.1%。2、经统计学分析发现性别、年龄、受伤方式与颈椎过伸伤员者的早期预后不具有统计学差异(P0.05)。脊髓损伤程度、有无伤前基础病变和治疗方式三方面具有统计学差异(P0.05)。手术组与保守组对比,差异具有统计学意义(P0.05)。手术组术前术后比较,差异具有统计学意义(P0.05)。结论1、性别、年龄、受伤方式与颈椎过伸伤员者的早期预后无明确的相关性。脊髓损伤程度、有无伤前基础病变、手术与否与颈椎过伸伤员者的早期预后有明确的相关性。脊髓的损伤程度分级低,无伤前基础病变及合理的手术治疗都可以改善患者的预后。颈椎过伸伤的发病机制、手术时机的选择、手术方式的选择等问题应获得进一步的研究,明确和细化手术的指征和时机,发现其中可能隐藏的问题。2、手术治疗的目的在于脊髓神经充分减压、维持或恢复颈椎的生理曲度和颈椎的稳定性。早期手术减压能减轻脊髓水肿,改善脊髓血液循环,避免脊髓缺血变性坏死导致的二次损伤,手术技术的提高使颈椎能获得即刻的稳定,帮助患者早期功能锻炼,减少各类并发症的发生。
[Abstract]:Cervical hyperextension injury is a common injury of cervical spinal cord, there have been reports that the cervical injury accounted for 35% of all kinds of damage, the statistics show that the ratio of up to 59.7%, there are usually minor or occult bone injury, while no obvious bony tissue damage or dislocation, which often cause misdiagnosis. Through the relevant factors on the prognosis of patients with cervical hyperextension injury analysis has important clinical significance. This study summarized in the collection, collation of Yangzhou First People's Hospital in recent 3 years, the clinical data of cervical hyperextension injury patients on the basis of the analysis of the related factors affecting the prognosis of cervical hyperextension injury, combined with X-ray, CT, MRI etc. imaging methods, efficacy analysis of the prognosis of cervical hyperextension injury associated with spinal stenosis patients after surgical treatment. Objective: 1, through retrospective analysis of clinical data of this study, nearly 3 years of clinical data in our hospital of cervical hyperextension injury were summarized, to investigate the prognostic factors of.2 patients were retrospectively analyzed the cases and -2016 images of 2013 years in our hospital, 17 cases of cervical hyperextension injury of the surgical treatment of data, to investigate the prognostic factors of cervical hyperextension surgery for patients the cervical vertebra injury. Materials and methods in our hospital in 2013 2016 after a department of orthopedics of Yangzhou First People's Hospital hospitalized patients and injury were collected, a total of 78 cases, respectively, from the gender, age and mechanism of injury may affect the prognosis related factors, according to the preoperative symptoms and signs of admission ASIA score, ASIA score before discharge and calculated the improvement rate. Chi square test and variance analysis of gender, age by Spss17.0 software, the degree of spinal cord injury, before injury without basic disease, early treatment, improve Whether there are differences. Results: 1, the Department of orthopedics of Yangzhou First People's Hospital from 2013 -2016, cervical hyperextension injury patients with a total of 78 cases were collected in cervical hyperextension injury in 78 cases, including 60 cases of male patients and 18 female patients. The improvement rate was 55%, 50%. were more concentrated in the elderly patients, including 51~60 and 71~80 years old were the most. The improvement rate was 76.5%, were in the form of 41.2%. patients are injured, falls, bruises, causing fights and other reasons, mainly in traffic accident (31 cases) and fall (19 cases), the total number of 64.1%. in which the improvement rates were 51.6% most of the patients, 57.9%. patients received conservative treatment or referral treatment, patients underwent surgical treatment (17 cases), only 1 cases had no obvious improvement, the rest of the patients were improved. The non operation treatment and operation of the two improvement rate of 94.1% and 41.7%. In patients with underlying diseases (51 cases) and more concentrated in the elderly patients, 21 cases were cured, patients without underlying diseases (27 cases) after treatment, 20 cases improved. The improvement rate was 41.2% and 74.1%.2 respectively, the statistical analysis found that gender, age, injury and prognosis of early cervical hyperextension the wounded were not statistically significant (P0.05). The degree of spinal cord injury, there is no significant difference among the three basic pathological changes and treatment before injury (P0.05). Compared with the surgical group and the conservative group, the difference was statistically significant (P0.05). The surgery group before and after surgery, the difference was statistically significant (P0.05). Conclusion: 1, gender, age, no correlation with prognosis of early cervical hyperextension injury of the wounded. The degree of spinal cord injury, there is no pre injury basic disease, surgery and not with cervical hyperextension of the wounded after the early pre have a clear correlation of the spinal cord. The injury degree of lower grade, no pre injury based lesions and surgical treatment can improve the prognosis of the patients. The pathogenesis of cervical hyperextension injury, timing of surgery, surgical options should be given further research problems, and clear indications and timing refinement operation, which may find hidden problems.2, surgical treatment to spinal cord decompression and stability to maintain or restore cervical lordosis and cervical spine. Early surgical decompression can relieve spinal cord edema of spinal cord, improve blood circulation, to avoid the two injury of spinal cord ischemia necrosis caused by the improvement of surgical technique that can obtain immediate stability of the cervical spine, help early functional exercise patients, reduce complications.

【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3
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本文编号：1500420