神经根型颈椎病手术治疗技术及预后因素分析

发布时间：2018-06-13 23:45

本文选题：颈椎病 + 神经根型颈椎病　；参考：《第二军医大学》2015年硕士论文

【摘要】：一、研究目的伴随我国人口老龄化,颈椎病发病人数明显增加,神经根型颈椎病作为发病率最高的颈椎病(Cervical Spondylotic Radiculopathy, CSR)占其中60%。神经根型颈椎病常导致颈肩背部疼痛、上肢及手指的放射性疼痛、麻木、无力,严重影响了人们的生活质量。既往对于神经根型颈椎病手术治疗方法选择及预后因素研究资料有限,在某些方面还存有争议,临床上对其认识还不够全面,常出现手术效果欠佳等情况,因此需要做更深入的研究。本研究主要研究神经根型颈椎病外科治疗方式及分析手术治疗预后影响因素。二、研究方法1.前瞻性研究2012年9月至2014年1月长征医院骨科收治的接受颈前路减压人工椎间盘置换术和植骨融合内固定术治疗神经根性颈椎病73例患者,其中男30例,女43例。采用随机分组方式,依据患者选择手术方式不同,分为两组,即人工椎间盘置换术组(CTDR组)35例(男16例,女]9例),平均年龄45.7岁(24-65)；椎间融合术组(ACDF组)38例(男14例,女24例)平均年龄46.5岁。平均随访1.4年,比较两组患者末次随访VAS(视觉模拟评分法)、NDI(颈部伤残指数)、SF-36PCS(生理部分PCS包含前4个维度的(PF、RP、BP和GH)、SF-36MCS(心理部分MCS包含了后4个维度(RE、SF、MH和VT))及手术相邻节段活动度(ROM)。研究对比以上两种手术方式治疗神经根型颈椎病的疗效差异及对手术相邻节段活动度的影响。2.回顾性研究2012年5月至2015年1月长征医院骨科收治的接受颈前路减压人工椎间盘置换术患者45例,根据NDI评分及术后复查结果确定治愈组与非治愈组。分析影响其手术效果相关因素。满足以下条件者为治愈组：1、NDI评分15分改进；2、手术节段神经根功能未出现持续性功能减退；3、未出现手术失败及二次手术；4、随访复查颈椎正侧位、动力位及左右侧屈X片未见人工椎间盘移位、活动受限及假体相关问题。以上4点不满足其中1点既为非治愈组。预后因素分为背景资料因素及主观变量因素。背景资料包括：性别,年龄,病程,吸烟习惯,肌电图确诊,肌力,手术节段,手术时间、出血量；主观变量：VAS(视觉模拟评分法),NDI(颈部伤残指数)。三、研究结果1.经过统计分析,人工椎间盘置换术组(CTDR)较椎间融合术组(ACDF)的出血量与手术时间无明显差异(出血量CTDR组184.9±40.5ml, ACDF组191.1±53.9m1,P0.05,手术时CTDR组144.5±14.0min, ACDF组145.2±15.1min,P0.05)。随访期间所有患者均未发现假体及椎间融合器松动脱落移位等。两组患者术后症状均比术前有明显改善。ACDF组与CTDR组术前及末次随VAS、NDI、SF-36PCS、SF-36MCS评分比较均无明显差异(P0.05)；ACDF组末次随访手术相邻上、下节段活动度与术前相比有明显差异(P0.05)；CTDR组术前与术后手术节段活动度相比较无明显差异,手术相邻上节段与下节段活动度与术前想比较均未见明显差异(P0.05)。2.治愈组为34人,未治愈组为11人,通过统计分析两组背景资料及主观变量,结果如下,患者年龄(p=0.012)、病程(p=0.007)、吸烟习惯(p=0.037)、肌电图确诊(p=0.007)、术前VAS(p0.001)、NDI (p0.001)对术后的恢复效果有统计学意义。性别(p=0.086),手术节段(p=0.260),颈椎ROM (p=0.521),手术时间(p=0.905)及出血量(p=0.543)对预后无统计学差异。四、结论：1.人工椎间盘置换术组与椎间融合术组随访发现两种手术方式治疗神经根型颈椎病手术效果无明显差别；人工椎间盘置换术不仅保留了手术节段的运动功能同时减少了临近节段影响：人工椎间盘置换术在治疗神经根型颈椎病是一种切实可行的手术方式。2.患者术前年龄小,病程短,低NDI评分,低VAS评分,无吸烟史,受压神经支配肌肉肌力高是预后的积极因素。性别、手术节段数量、术前手术节段活动度、手术时间、手术出血量等对预后无明显影响。
[Abstract]:First, the study aims to increase the number of cervical spondylosis with the aging of the population in China. The cervical spondylosis of the nerve root type is the highest incidence of cervical spondylosis (Cervical Spondylotic Radiculopathy, CSR), and the cervical spondylosis of 60%. is often caused by the pain of the neck and shoulder, and the radiation pain, numbness and weakness of the upper limbs and the fingers are seriously affected. The quality of life of the people is limited. There are still some disputes about the choice of surgical treatment and the prognostic factors of the cervical spondylosis of the nerve root type. Two, study method 1. prospective study of 73 patients with Radicular Cervical Spondylosis Treated by anterior cervical decompression artificial disc replacement and implant fusion internal fixation in Department of orthopedics of Changzheng Hospital from September 2012 to January 2014, including 30 male and 43 female patients, which were randomly divided into groups. According to the choice of surgical methods, two groups were divided into two groups: artificial disc replacement (group CTDR) 35 cases (male 16, female]9), average age 45.7 years (24-65); interbody fusion group (group ACDF) 38 cases (male 14, female 24) average age 46.5 years old. Average follow-up 1.4 years, compared to group two patients last follow-up VAS (visual analogue scoring), NDI (neck (neck)), NDI (neck) SF-36PCS (physiological part PCS contains the first 4 dimensions (PF, RP, BP and GH), SF-36MCS (psychological part MCS contains the last 4 dimensions (RE, SF, MH and VT)) and the adjacent segments of the operation. The study compares the difference between the curative effects of the two surgical methods for the treatment of the cervical spondylosis of the deity and the activity of the adjacent segments of the operation A retrospective study of 45 patients receiving cervical anterior decompression and disc replacement admitted in Department of orthopedics of the Changzheng Hospital from May 2012 to January 2015. According to the NDI score and the reexamination results, the curative and non cured groups were determined. The factors affecting the surgical results were analyzed. The following conditions were treated as the cure group: 1, the NDI score was improved by 15 points; 2, hand. There was no persistent dysfunction in the nerve root function of the segment; 3, no surgical failure and two operations were not appeared; 4, follow-up examination of cervical vertebra positive lateral position, power position and left and right lateral flexion X films did not have artificial intervertebral disc displacement, movement restriction and prosthesis related problems. The above 4 points were not satisfied with 1 points not cured. The prognostic factors were divided into background data. Background data including sex, age, course of disease, smoking habits, electromyogram diagnosis, muscle strength, surgical segment, operation time, bleeding volume; subjective variables: VAS (visual analogue score), NDI (cervical disability index). Three, 1. by statistical analysis, artificial disc replacement group (CTDR) compared with interbody fusion group (CTDR) There was no significant difference between the bleeding volume of ACDF and the operation time (group CTDR 184.9 + 40.5ml, group ACDF, 191.1 + 53.9m1, P0.05, CTDR group 144.5 + 14.0min, ACDF 145.2 + 15.1min, P0.05). No prosthesis and interbody fusion exfoliation and displacement were found in all patients during the follow-up period. The postoperative symptoms of the two groups were significantly better than those before the operation. There was no significant difference between.ACDF group and group CTDR before and after the operation of VAS, NDI, SF-36PCS and SF-36MCS (P0.05). The activity degree of the lower segment in the last follow-up operation of ACDF group was significantly different from that before the operation (P0.05), and there was no significant difference between the preoperative and postoperative segment activity of the CTDR group, and the operation adjacent to the upper and lower segments was adjacent to the operation. There was no significant difference between the activity degree and the preoperative thought (P0.05).2. cured group was 34, and the uncured group was 11. Through statistical analysis of two groups of background data and subjective variables, the results were as follows: patient's age (p=0.012), course of disease (p=0.007), smoking habit (p=0.037), electromyography (p=0.007), preoperative VAS (p0.001), NDI (p0.001) to postoperative recovery effect. The results were statistically significant. There was no statistical difference between sex (p=0.086), surgical segment (p=0.260), cervical ROM (p=0.521), operation time (p=0.905) and bleeding volume (p=0.543). Four. Conclusion: 1. the results of two surgical methods for the treatment of cervical spondylotic radicular spondylosis have no significant difference in the group of artificial disc replacement and interbody fusion. Artificial disc replacement not only preserves the movement function of the segment of the operation, but also reduces the influence of adjacent segments: artificial disc replacement in the treatment of Radicular Cervical spondylosis is a practical way of surgical treatment of.2. patients with small preoperative age, short course of disease, low NDI score, low VAS score, no smoking history, and muscle muscle strength controlled by compression nerve. Height is a positive factor for prognosis. Gender, number of operative segments, preoperative operative segment activity, operative time, and operative blood loss have no significant effect on prognosis.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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