前路与后路矫形手术治疗颈椎后凸畸形的临床疗效分析

发布时间：2018-05-26 23:25

本文选题：颈椎后凸畸形 + 前路　；参考：《广西医科大学》2015年硕士论文

【摘要】：目的:分析前路与后路矫形手术治疗颈椎后凸畸形的临床疗效,为临床选择手术入路提供参考。方法:回顾性分析2008年1月-2013年12月,广西医科大学第一附属医院共收治61例颈椎反曲畸形的患者。男性患者37例,女性患者24例,年龄在2~78岁之间,平均(43.7±15.0)岁。按引起后凸畸形的病因分为:医源性(主要为颈椎板切除未做内固定的患者)后凸29例,外伤性后凸16例,退变性后凸12例,疾病性后凸畸形4例。术前JOA评分5~12分,均值为(8.70±1.67)分;术前反曲Cob b角在9.3°~28.2°之间,均值为(14.4±3.3)°,行颈椎后凸畸形矫形手术。其中39例⺌Cobb角在9.3°~19.5°之间,平均(14.1±2.7)°,其中:医源性患者涉及3个及以内节段;外伤性患者为损伤前柱或部分中柱且后柱完好;退变性患者主要为涉及前柱、中柱及椎间盘部分伴有后纵韧带骨化;疾病性患者畸形涉及少于3个节段。以上所有病例无颈椎后柱骨性融合,术前JOA评分(8.54±1.70)分⺗行前路手术;22例⺌Cobb角9.6°~28.2°,平均(15.1±4.3)°,其中:医源性患者涉及3个以上节段;外伤性患者为后柱或部分伴中柱受损但无骨性移位的病例;退变性患者为后柱出现骨性融合;疾病性患者为涉及三个以上椎体的病例。以上所有病例均无颈椎前柱骨性融合,术前平均JOA评分(9.00±1.63)分⺗行后路手术。记录并分析患者手术时间、手术中出血量、住院天数,术前、术后及末次随访的JOA评分、Cobb角度数的变化。结果:39例前路手术的患者的平均手术时间为(111.6±38.4)min,术中平均失血量为(335.6±308.3)ml,平均住院时间(12.6±6.0)天;术后Cobb角为(5.1±1.2)°与术前比较有明显减小,术后即刻反曲畸形矫正率平均(63.0±9.4)%;12~31个月的随访,平均约21个月,最后一次随访时Cobb角平均为(6.5±1.3)°与术前比较有较明显减小,平均矫正丢失率达(16.2±7.0)%;术后一周内JOA评分为(11.82±1.55)分,最后一次随访时JOA评分为(15.53±1.41)分,与术前比较均有明显改善,末次随访改善率为(83.8±13.0)%。22例后路手术患者的平均手术时间为(146.5±60.3)min,手术中平均出血达(661.4±330.2)ml,平均住院天数为(17.3±6.4)天;术后Cobb角为(9.1±2.6)°与术前比较有明显减小,术后即刻反曲畸形矫正率平均(39.2±9.1)%;12-54个月的随访,平均随访约25个月,末次随访时Cobb角为(10.0±3.4)°与术前比较有较明显减小,其矫正丢失率为(13.3±27.7)%;术后一周内JOA评分为(11.31±1.04)分,最后一次随访JOA评分为(15.04±1.76)分,与术前比较均有明显改善,末次随访改善率为(76.3±20.1)%。结论:前入路和后入路矫形手术方式均是。前入路较后入路矫正颈椎后凸畸形术具有手术时间短、住院时间少,出血量少等优点。
[Abstract]:Objective: to analyze the clinical effect of anterior and posterior orthopedic surgery in the treatment of cervical kyphosis. Methods: from January 2008 to December 2013, 61 patients with cervical reflexive deformity were treated in the first affiliated Hospital of Guangxi Medical University. There were 37 males and 24 females, aged between 2 and 78 years, with an average age of 43.7 卤15.0 years. According to the causes of kyphosis, 29 cases of iatrogenic kyphosis, 16 cases of traumatic kyphosis, 12 cases of degenerative kyphosis and 4 cases of diseased kyphosis were divided into three groups: iatrogenic kyphosis (29 cases), traumatic kyphosis (16 cases) and degenerative kyphosis (4 cases). The preoperative JOA score ranged from 5 to 12 with an average of 8.70 卤1.67, and the preoperative Cob b angle was between 9.3 掳and 28.2 掳, with a mean of 14.4 卤3.3 掳. Among them, 39 cases had Cobb angle between 9.3 掳and 19.5 掳, with an average of 14.1 卤2.7 掳. Among them, iatrogenic patients involved 3 or more internal segments, traumatic patients were injured anterior column or part of middle column and posterior column was intact, degenerative patients mainly involved anterior column. Medial column and intervertebral disc with ossification of posterior longitudinal ligament; deformities of diseased patients involved less than 3 segments. There was no posterior column bone fusion in all of the above cases. The preoperative JOA score was 8.54 卤1.70? 22 cases underwent anterior approach with Cobb angle 9.6 掳卤28.2 掳(mean 15.1 卤4.3 掳), in which iatrogenic patients involved more than 3 segments, traumatic patients with posterior column or part with middle column damage but no bone displacement, degenerative patients with posterior column bone fusion. Diseased patients are cases involving more than three vertebrae. There was no anterior column bony fusion in all of the above cases. The mean preoperative JOA score was 9.00 卤1.63? Perform posterior surgery. The time of operation, the amount of blood lost during operation, the days of hospitalization, the changes of JOA score and Cobb angle of preoperative, postoperative and last follow-up were recorded and analyzed. Results the mean operative time, blood loss and hospital stay were 111.6 卤38.4 min, 335.6 卤308.3 ml and 12.6 卤6.0 days respectively, and the postoperative Cobb angle of 5.1 卤1.2 掳decreased significantly compared with those before operation. The mean Cobb angle at the last follow-up was 6.5 卤1.3 掳, and the average corrected loss rate was 16.2 卤7.0 掳, the JOA score was 11.82 卤1.55 in the first week after operation, and the JOA score was 15.53 卤1.41 at the last follow-up. The average operative time was 146.5 卤60.3 min, the mean bleeding was 661.4 卤330.2ml, the average hospital stay was 17.3 卤6.4 days, and the postoperative Cobb angle was 9.1 卤2.6) 掳. The average correction rate was 39.2 卤9.1% for 12-54 months, and the average follow-up was 25 months. The Cobb angle was 10.0 卤3.4 掳at the last follow-up, and the corrected loss rate was 13.3 卤27.7%, and the JOA score was 11.31 卤1.04) in the first week after operation. The JOA score of the last follow-up was 15.04 卤1.76, and the improvement rate was 76.3 卤20.1%. Conclusion: both anterior approach and posterior approach are orthopedic. The anterior approach has the advantages of shorter operation time, less hospital stay and less bleeding than posterior approach for correction of cervical kyphosis.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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