颈前路减压融合内固定治疗颈椎过伸性损伤

发布时间：2018-06-19 08:38

本文选题：过伸性颈椎损伤 + 前路减压　；参考：《福建医科大学》2015年硕士论文

【摘要】：目的:探讨颈前路减压融合内固定术治疗颈椎过伸性损伤临床疗效及手术时机、后纵韧带处理对手术疗效的影响。方法:通过回顾性分析我科2012年3月至2014年3月收治52例具有完整临床资料颈椎过伸性损伤患者的相关信息;收集记录手术时间、出血量及相关并发症,观察记录术前、术后1年神经功能Frankel分级变化,所有病人在术前、术后3个月、术后1年拍摄颈椎正侧位X片测量颈椎融合节段曲度Cobb角、椎间高度变化,术后1年拍摄颈椎正侧位X片判断钛网植骨融合情况等评估颈前路减压融合内固定术的临床疗效。结果:52例患者平均手术时间115.45±39.67min,术中出血147.94±103.72ml。全部患者随访时间12-17个月,术前不适症状均有不同程度改善。Frankel分级:Frankel A级5例,3例无恢复,恢复到B级1例,C级1例;Frankel B级23例,恢复到C级13例,D级2例,E级8例;Frankel C级22例,恢复到D级17例,E级5例;Frankel D级2例,恢复到E级2例;3例脊髓功能无明显恢复,但临床疼痛、麻木等症状明显得到缓解;颈椎融合节段Cobb角术前8.84±6.76°,术后3月为11.46±8.96°,术后1年为11.27±9.17°;颈椎融合节段椎间高度术前为60.12±14.31mm,术后3月为63.98±14.78 mm,术后1年为63.28+13.67 mm。术后神经功能Frankel分级、颈椎融合节段Cobb角、颈椎融合节段椎间高度均较术前明显提高(p0.05)。末次随访未发现假关节形成、植骨块脱出、钛板螺钉松动断裂等并发症。手术干预时机(P㩳0.05)及是否切除后纵韧带(P0.05)对颈椎过伸性损伤术后神经功能恢复有影响。结论:早期充分彻底地解除脊髓压迫,恢复颈椎椎间高度和生理曲度对于治疗颈椎过伸性损伤具有显著的疗效;切除肥厚增生的后纵韧带可以使颈髓前后减压更加充分;颈前路减压钛网植骨融合内固定术后颈椎可获得即刻稳定性,有效维持椎间高度和曲度,促进植骨融合,在神经功能恢复方面可达到满意疗效,有利于患者早期功能锻炼。
[Abstract]:Objective: to investigate the effect of anterior cervical decompression, fusion and internal fixation on cervical hyperextension injury. Methods: from March 2012 to March 2014, 52 patients with cervical hyperextension injury were treated in our department from March 2012 to March 2014. One year after operation, the neurological function Frankel grade was changed in all the patients. The curvature of cervical fusion segment Cobb angle and the height of cervical vertebrae were measured by X ray of cervical vertebrae anterior and lateral position before operation, 3 months after operation and 1 year after operation. To evaluate the clinical effect of anterior cervical decompression, fusion and internal fixation with titanium mesh bone graft, X-ray film of cervical vertebrae was taken 1 year after operation. Results the mean operative time was 115.45 卤39.67 min and the intraoperative bleeding was 147.94 卤103.72 ml. All the patients were followed up for 12-17 months. The symptoms of the patients were improved in varying degrees. Frankel grade: Frankel grade A (5 cases) did not recover in 3 cases, but recovered to grade B (1 case), grade C (1 case) and Frankel grade B (23 cases). The patients recovered to grade C (n = 13), grade D (n = 2), grade E (n = 8), grade C (n = 22), grade D (n = 17), grade E (n = 5), grade D (n = 2), and grade E (n = 2). The Cobb angle of cervical fusion segment was 8.84 卤6.76 掳before operation, 11.46 卤8.96 掳before operation, 11.27 卤9.17 掳at 1 year after operation, and 60.12 卤14.31 mm before operation, 63.98 卤14.78 mm in 3 months after operation and 63.28 13.67 mm in 1 year after operation. The postoperative neurological function Frankel grade, Cobb angle of cervical fusion segment, and intervertebral height of cervical fusion segment were significantly higher than those of preoperation. At the last follow-up, there were no complications such as pseudarthrosis, bone graft prolapse, loosening and fracture of titanium plate and screw. The timing of surgical intervention (P0.05) and the removal of posterior longitudinal ligament (P0.05) had an effect on the recovery of nerve function after cervical hyperextension injury. Conclusion: it is effective to treat cervical hyperextension injury by removing spinal cord compression fully and thoroughly at early stage, restoring cervical intervertebral height and physiological curvature, and removing hypertrophic posterior longitudinal ligament can make cervical spinal cord decompression more fully. Anterior cervical decompression and titanium mesh fusion and internal fixation can obtain immediate stability, maintain intervertebral height and curvature effectively, promote bone graft fusion, and achieve satisfactory results in the recovery of nerve function, which is beneficial to early functional exercise of patients.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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