颈椎后路单开门椎管扩大成形术门轴折断与轴性症状的相关性

发布时间：2018-04-12 16:51

本文选题：颈椎病 + 颈椎后路成形术　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:探讨颈椎后路单开门椎管扩大成形术门轴折断与轴性症状的相关性。方法:纳入自2014年11月至2016年11月在青岛大学附属医院同一名医师进行颈椎后路椎管扩大椎板成形术,采用微型ARCH钛板内固定,且资料完整的共有67人,男47人,女20人,年龄41-78岁,平均65岁。手术开门减压节段在C3-C7共43例、在C3-C6共15例、在C4-C7共2例、在C4-C6共5例,记录术后患者出现颈肩部酸胀、僵硬、沉降感及肌肉痉挛的发生情况及程度,轴性症状程度分类:没有轴性症状(NO);经常发生轴性症状,但是没有影响到日常活动(MILD);由于轴性症状影响到日常的生活和工作(SEVERE)。根据术后1周颈椎CT复查结果,将门轴侧椎板折断情况分为三类:1.不完全骨折;2.完全骨折骨断端无移位;3.完全骨折骨断端移位。复查术后3月、6月颈椎CT评估门轴侧骨断端愈合情况。随访患者神经功能恢复情况(JOA评分、NDI评分、VAS评分)。进行术后1周门轴侧椎板折断率与术后3月轴性症状发生率的相关性分析,术后1周门轴侧椎板折断类型与术后3月轴性症状严重程度的相关性分析,并进行术后6月门轴愈合率与轴性症状缓解率的相关性分析。结果:手术均顺利完成,随访时间4-10个月,平均6个月,随访期间未发生螺钉松动、钛板移位及椎板再关门现象。由于术中门轴折断导致椎板游离,直接切除3个椎板,共记录295个椎板,共获得6个月完整随访资料的脊髓型颈椎病患者67例。应用定量资料t检验,比较手术前后JOA评分、VSA评分、NDI评分,具有显著统计学意义(P0.01),术后1周门轴侧椎板折断率27.6%,共有81个椎板折段:不完全骨折37个;完全骨折骨断端无移位31个;完全骨折骨断端移位13个。发生术后椎板折断病例50例,以椎板折断较严重类型记:不完全骨折19例;完全骨折骨断端无移位18例;完全骨折骨断端移位13例。术后3月轴性症状发生率为32/67:MILD18例(其中有3例患者术后1周复查颈椎CT门轴未见椎板骨折);SEVERE14例。术后6月84.2%病人门轴侧椎板全部融合(椎板腹侧及背侧骨皮质均愈合),轴性症状由SEVERE缓解至MILD、NO13例,由MILD缓解至NO10例,未见轴性症状加重患者。应用卡方检验分析术后1周门轴的折断率与术后3月轴性症状的发生率的相关性,具有相关性(?2=9.23?20.05,1),分析术后1周门轴侧椎板的折断类型与术后3月轴性症状程度的相关性,具有相关性(?2=18.996?20.05,4=7.81),分析术后6月门轴侧椎板融合率与轴性症状缓解率的相关性,具有相关性(?2=5.79?20.05,1)。结论:颈椎后路单开门椎管扩大成形术,采用微型钛板内固定,可改善脊髓及神经根压迫症状。术后门轴侧的椎板折断,尤其是门轴折断并移位是术后轴性症状发生的主要原因之一,门轴融合可有效缓解术后轴性症状。
[Abstract]:Objective: to investigate the relationship between axial symptoms and fracture of portal axis in posterior cervical open door laminoplasty.Methods: from November 2014 to November 2016, 67 patients (47 males and 20 females) underwent posterior cervical vertebrae laminoplasty in Qingdao University affiliated Hospital.The age ranged from 41 to 78 years with an average of 65 years.Open door decompression was performed in 43 cases in C3-C7, 15 cases in C3-C6, 2 cases in C4-C7 and 5 cases in C4-C6. The occurrence and degree of acidosis, stiffness, sedimentation and muscle spasm were recorded.Degree of axial symptoms: no axial symptoms; often developed axial symptoms, but did not affect the daily activities of MILDD; due to axial symptoms affect daily life and work of SEVEREN.According to the results of cervical CT reexamination 1 week after operation, the fracture of the hilar axial lamina was divided into three types: 1: 1.Incomplete fracture 2.No displacement was found at the broken end of the bone in complete fracture.Displacement of broken end of bone in complete fracture.3 months after operation, 6 months after operation, cervical CT was used to evaluate the healing of the broken end of the hilar axial bone.The neurologic function recovery was evaluated by JOA score and NDI score and VAS score.The correlation between the healing rate of portal axis and the relief rate of axial symptoms was analyzed 6 months after operation.Results: all the operations were completed successfully, the follow-up time was 4-10 months (mean 6 months). No screw loosening, titanium plate displacement and lamina closure were observed during the follow-up period.Due to the dissociation of the lamina due to the fracture of the portal axis during the operation, three laminae were removed directly, 295 laminae were recorded, and 67 patients with cervical Spondylotic myelopathy were followed up for 6 months.T test of quantitative data was used to compare JOA score and JOA score before and after operation. There was significant statistical significance (P 0.01). 1 week after operation, the fracture rate of portal-axial lamina was 27.60.There were 81 laminar fractures: 37 incomplete fractures.There were 31 cases of complete fracture and 13 cases of complete fracture.There were 50 cases of fracture of vertebral lamina after operation, 19 cases of incomplete fracture, 18 cases of complete fracture without displacement, 13 cases of complete fracture of broken end of bone.Three months after operation, the incidence of axial symptoms was 32/67:MILD18 in 14 cases.In 84.2% of the patients, the hilar and axial laminae were fused at 6 months after operation. The axial symptoms were relieved from SEVERE to MILDN in 13 cases and from MILD to NO10 in 13 cases. There were no cases with aggravated axial symptoms.Chi-square test was used to analyze the correlation between the fracture rate of portal axis 1 week after operation and the incidence of axial symptoms at 3 months after operation. The correlation was found between the type of fracture of portal axial lamina 1 week after operation and the degree of axial symptoms at 3 months after operation.Conclusion: posterior open door laminoplasty and mini-titanium plate fixation can improve the compression symptoms of spinal cord and nerve root.The fracture of the lamina of the portal axis, especially the fracture and displacement of the portal axis, is one of the main causes of postoperative axial symptoms, and portal-axis fusion can effectively relieve the postoperative axial symptoms.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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