比较前路两种术式对相邻双节段颈椎病曲度及疗效的影响

发布时间：2018-02-20 16:29

本文关键词： 前路减压植骨融合术颈椎病颈椎生理曲度　出处：《吉林大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:比较椎体次全切除减压植骨融合术(Anterior Cervical Corpectomy and Fusion,ACCF)与经椎间隙减压植骨融合术(Anterior Cervical Discectomy and Fusion,ACDF ACDF)对双节段相邻颈椎病患者的颈椎曲度影响及临床疗效评价,为此类病人行手术治疗时,给术者提供何种术式的参考。资料与方法:选取2013年8月-2016年10月年在吉林大学中日联谊医院因相邻双节段颈椎病而行椎体次全切除减压植骨融合术与经椎间隙减压植骨融合术(以下称ACCF、ACDF)的患者47例,其中接受ACCF的患者25例(A组),接受ACDF的患者22(B组)例。两组患者影像学资料提示脊髓或神经根受到压迫,相关检查明确压迫物在椎管前方并表现压迫所致相应临床症状及体征;术前行正规保守治疗6个月以上症状无明显好转者。记录患者术前、术后融合节段Cobb角及C2-7Cobb角、D值及JOA评分,应用SPSS22.0比较两种手术对颈椎曲度及临床疗效的差异。结果:两组患者术后均得到有效随访,平均随访时间12个月。治疗相邻两节段颈椎病时B组出血少、住院时间短特点。A、B两组术后JOA评分较术前明显提高,患者症状缓解满意,对比术前差异均有显著统计学意义(P0.05);A、B两组间无统计学差异(P0.05)。颈椎融合节段Cobb角度较术前有统计学差异(P0.05),组间无差异(P0.05)。随着时间推移,长远期ACDF的Cobb角恢复优于ACCF,组间C2-7Cobb角存在差异(t=3.161,P=0.003)。结论:1.严格掌握手术适应症,治疗相邻节段颈椎病时在排除发育型颈椎管狭窄、椎体后缘并发后纵韧带骨化、终板附有较大骨赘者首选ACDF,它较ACCF相比更有益于颈椎生理曲度的恢复,从而为植骨融合稳定性方面提供力学平衡。2.颈椎前路椎间盘切除减压椎间融合器融合术和颈椎前路椎体次全切除减压钛网重建钢板板内固定术治疗邻近双节段颈椎病均取得良好临床疗效,均可改善神经功能且疗效无差异。
[Abstract]:Objective: to compare the effect of anterior Cervical Corpectomy and fusion (ACCF) and intervertebral space decompression and and fusion (ACDF) on cervical curvature and clinical efficacy in patients with two-segment adjacent cervical spondylosis. When surgical treatment is performed on such patients, Data and methods: selected from August 2013 to October 2016 in the Sino-Japanese Friendship Hospital of Jilin University for adjacent double-segment cervical spondylosis and performed subtotal vertebral body decompression bone graft fusion and intervertebral space. 47 patients underwent decompression and bone grafting and fusion (hereinafter referred to as ACCFU ACDF). There were 25 cases of ACCF in group A and 22 cases in group B of ACDF. The imaging data of the two groups showed that the spinal cord or nerve root was compressed. The relevant examination confirmed that the compression material was in front of the spinal canal and showed the corresponding clinical symptoms and signs caused by compression. Patients who received regular conservative treatment for more than 6 months had no obvious improvement of symptoms before and after operation. The Cobb angle of fusion segment and the D value of C2-7 Cobb angle and JOA score were recorded before and after operation. SPSS22.0 was used to compare the difference of cervical curvature and clinical efficacy between the two operations. Results: all the patients in the two groups were followed up effectively after operation, the average follow-up time was 12 months. The bleeding in group B was less when treating adjacent cervical spondylosis. The JOA score of the two groups after operation was significantly higher than that before operation, and the symptoms of the patients were relieved satisfactorily. There was no statistical difference between the two groups (P 0.05). The Cobb angle of cervical fusion segment was significantly different from that before operation (P 0.05), and there was no difference between the two groups (P 0.05). The recovery of Cobb angle in long and long term ACDF was better than that in ACCF, and there was a difference in C2-7 Cobb angle between groups. Conclusion\\\%\\\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%\%? In the endplate with larger osteophytes, ACDF is the first choice, which is more beneficial to the recovery of cervical physiological curvature than ACCF. So as to provide a mechanical balance for the stability of bone graft fusion. 2. Anterior cervical disc resection, decompression, interbody fusion, cage fusion and anterior cervical vertebra subtotal decompression and titanium mesh reconstruction plate internal fixation for adjacent two-segment neck. Good clinical effects were obtained in patients with vertebra disease. All of them could improve the nerve function and there was no difference in the curative effect.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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