颈后路责任节段椎管扩大减压术的研究

发布时间：2018-05-29 09:31

本文选题：颈椎病 + 颈后路　；参考：《郑州大学》2017年硕士论文

【摘要】：1研究背景及目的传统C3~C7颈椎后路椎管扩大减压术和单开门椎管扩大成形术是治疗先天性颈椎管狭窄症,多节段脊髓型颈椎病、颈椎黄韧带及后纵韧带肥厚和骨化等引起的继发性广泛性颈椎管狭窄症的常见术式,已广泛应用于临床数十年,其术后疗效已得到充分的认可,但此术式术后并发症也逐渐被广大医生所认识,术后主要并发症包括颈肩部轴性痛、颈椎生理性曲度丢失、颈椎活动度下降、神经根麻痹等。近年的研究发现:颈椎后伸肌群对维持颈椎正常生理曲度及颈椎的稳定性作用重要,术后颈椎生理曲度的丢失和轴性疼痛的产生与颈椎后路手术损伤后伸肌群及其止点有关。我们采用了责任节段椎管扩大减压术,术中仅处理脊髓和神经根受压的节段,尽可能的保留非责任节段的棘突肌肉止点,通过对责任节段颈后路椎管扩大减压术(包括成形术)与传统C3~C7节段颈后路减压术(包括成形术)治疗多节段颈椎管狭窄症的早期疗效随访,对随访数据进行分析,总结责任节段颈后路椎管扩大减压术(包括成形术)术后疗效。2方法回顾性分析自2013年1月到2016年1月在我院因多节段颈椎间盘突出、后纵韧带骨化、黄韧带肥厚所致的多节段颈椎管狭窄症,在我院行颈后路手术的患者77例,责任节段颈后路椎管扩大减压术组(实验组)34例,传统C3~C7节段颈后路减压术组(对照组)43例,进行早期随访调查研究,比较手术时间、手术出血量、术前及术后随访时JOA评分、VAS评分、神经功能改善率等,进行分析研究。3结果两组患者术前与术后各阶段随访JOA评分及神经功能改善率差异无统计学意义(P0.05),两组患者术前及术后3月VAS评分差异无统计学意义(P0.05),术后6、12月及末次随访VAS评分差异有统计学意义(P0.05),实验组优于对照组。两组术式术中出血量、手术时间差异有统计学意义(P0.05),实验组优于对照组。4结论1.与传统的C3~C7颈后路椎管扩大减压术比较,责任节段颈后路椎管扩大减压术同样能取得良好的临床疗效;2.责任节段减压手术时间短、术中出血量少;3.责任节段减压术较传统后路手术能够能较好的改善患者早期的主观疼痛症状。
[Abstract]:Background and objective traditional C3~C7 posterior spinal canal decompression and open door laminoplasty were used to treat congenital cervical spinal stenosis and multilevel cervical Spondylotic myelopathy. The common surgical procedures for secondary generalized cervical spinal canal stenosis caused by hypertrophy and ossification of ligamentum flavum and posterior longitudinal ligament have been widely used in clinical practice for decades. However, the complications of this operation have been gradually recognized by doctors. The main postoperative complications include neck and shoulder axial pain, loss of physiologic curvature of cervical vertebrae, decreased cervical movement, nerve root paralysis and so on. In recent years, it has been found that the posterior extensor muscle group plays an important role in maintaining the normal cervical curvature and the stability of the cervical spine. The loss of the cervical vertebra physiological curvature and the occurrence of axial pain are related to the extensor muscle group and its stopping point after posterior cervical surgery injury. We used the extended decompression of the responsible segmental spinal canal to treat only the spinal cord and nerve root compression segments, and to preserve as much as possible the spinous process muscle endpoints in the non-responsible segments. The early follow-up results of extended decompression of the responsible posterior cervical canal (including angioplasty) and traditional C3~C7 decompression (including angioplasty) in the treatment of multilevel cervical spinal stenosis were analyzed. To summarize the curative effect of extended decompression of the posterior cervical canal (including plasty). Methods from January 2013 to January 2016, we analyzed retrospectively the ossification of posterior longitudinal ligament due to multiple cervical disc herniation in our hospital. 77 cases of multilevel cervical spinal stenosis caused by hypertrophy of ligamentum flavum were treated by posterior cervical surgery in our hospital, and 34 cases were treated with extended decompression of posterior cervical spinal canal (experimental group, 34 cases), and 43 cases were treated with traditional C3~C7 posterior cervical decompression (control group, 43 cases). Early follow-up study was carried out to compare the operation time, the amount of blood loss, the JOA score before and after operation, the improvement rate of nerve function, and so on. Results there was no significant difference in JOA score and neurological function improvement rate between the two groups before and after operation (P 0.05). There was no significant difference in VAS score between the two groups before and 3 months after operation (P 0.05), but in 6 months and 12 months after operation, there was no significant difference in VAS score between the two groups. The difference of VAS score was statistically significant (P 0.05), and the experimental group was superior to the control group. There was significant difference in blood loss and operation time between the two groups (P 0.05), and the experimental group was superior to the control group (P 0.05). Conclusion 1. Compared with the traditional posterior cervical decompression with C3~C7, the extended decompression of the posterior cervical canal of the responsible segment can also obtain good clinical effect. The operative time of responsible segment decompression was short and the amount of blood lost during operation was less than 3%. Responsibility segmental decompression can improve patients' subjective pain symptoms better than traditional posterior approach.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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