两种颈椎前路手术治疗单节段颈椎病的对比

发布时间：2018-04-14 08:56

本文选题：颈椎前路手术 + 自体髂骨　；参考：《吉林大学》2015年硕士论文

【摘要】：目的：阐述两种颈椎前路手术对单节段颈椎病患者愈后的影响。方法：回顾2012年7月至2014年6月单节段颈椎病患者55名，分为A、B两组。其中A组(颈椎前路间盘摘除同种异体骨垫植入锁定钢板螺丝钉内固定)43名患者，其中男25例，女18例，年龄34-68岁，，平均年龄51.4岁；B组(颈椎前路间盘摘除自体髂骨植入锁定钢板螺丝钉内固定)12名患者，其中男7例，女5例；年龄为42-71岁，平均年龄为57.7岁；临床疗效评估采用：对患者手术的时间、手术出血量、术后并发症、颈椎融合情况、颈椎融合节段椎体前后高度改变（HAB、HPB）、颈椎曲度改变(应用D值、cobb角)、钢板及钛网的位置是否改变、神经功能改善（采用mJOA评分）及生活质量状况（应用SF-36量表）进行统计对比。结果：术后随访时间为9-18个月，平均随访时间12个月，A组与B组手术时间、手术出血量、HAB及HPB、D值及cobb角改变有统计学意义(P＜0.05)；而A组与B组椎体融合率、mJOA评分无统计学意义(P＞0.05)；两组均未发生钛网或（及）钢板位置的改变；B组有7例患者出现髂骨取骨处疼痛；通过SF-36量表分析，对两组患者进行生活质量评估发现,文化程度、职业、医疗费用来源是影响其手术方式选择的主要因素。结论： 1.两种颈椎前路手术治疗单节段颈椎病椎体融合率相当，取髂骨可增加手术时间及手术出血量； 2.取髂骨组与骨垫组比较，前者HAB、HPB、D值、cobb角改变较明显；两组HAB、HPB、D值及cobb角均在术后3个月内变化幅度较大；术后3个月后HAB、HPB、D值及cobb角两组均趋于稳定； 3.在一定时期内相同阶段，两种手术颈椎融合率、HAB及HPB减小、D值及cobb角改变与mJOA评分无明确相关性，但其远期相关性有待进一步研究； 4.颈椎前路手术应用同种异体骨垫与自体髂骨治疗颈椎病均能使神经功能得到明显改善，文化程度、职业、医疗费用来源是影响其手术方式选择的主要因素；
[Abstract]:Objective: to study the effect of two kinds of anterior cervical surgery on the recovery of patients with single cervical spondylosis.Methods: from July 2012 to June 2014, 55 patients with single cervical spondylosis were divided into two groups.In group A, 43 patients (25 males and 18 females aged 34 to 68 years old) were treated with locking plate screw fixation, including 25 males and 18 females.The average age of group B was 51.4 years old (12 patients (7 males and 5 females) with internal fixation of locking plate screw, 42-71 years old, with an average age of 57.7 years).The time of operation, the amount of blood loss, postoperative complications and cervical fusion were evaluated.The changes of anterior and posterior height of cervical fusion segment, cervical curvature (using D value of cobb angle, the position of plate and titanium mesh), the improvement of nerve function (mJOA score) and the quality of life (SF-36 scale) were compared statistically.Results: the follow-up time was 9-18 months, and the average follow-up time was 12 months.There were significant changes in Hab and HPBG D and cobb angle between group A and group B (P < 0.05), but there was no significant difference in spinal fusion rate between group A and group B (P > 0.05), and there was no change in titanium mesh or / or plate position in group B (n = 7).Pain at iliac bone extraction;The quality of life (QOL) of the two groups of patients was evaluated by SF-36 scale. It was found that the educational level, occupation and source of medical expenses were the main factors affecting the choice of operation mode.Conclusion:1.The fusion rate of the two anterior cervical vertebrae for single cervical spondylosis was similar, and the operation time and the amount of blood loss could be increased by iliac bone extraction.2.In the iliac bone group and the bone pad group, the cobb angle and the cobb angle of the two groups changed more obviously than those of the bone pad group, and the cobb angle and the cobb angle of the two groups tended to be stable 3 months after operation.3.At the same stage in a certain period, there was no clear correlation between the rate of cervical fusion and the decrease of D value of HPB and the change of cobb angle with mJOA score, but the long-term correlation of the two operations needed to be further studied.4.Anterior cervical surgery with allogeneic bone pad and autogenous iliac bone for cervical spondylopathy can significantly improve the neurological function, education level, occupation, medical expenses are the main factors affecting the choice of surgical methods.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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