零切迹椎间融合器（Zero-P）治疗脊髓型颈椎病的临床疗效观察

发布时间：2018-06-20 20:44

本文选题：脊髓型颈椎病 + 针灸　；参考：《长春中医药大学》2015年硕士论文

【摘要】：背景:颈椎病是危害人体健康的常见病及多发病。其中脊髓型颈椎病约占颈椎病的10%-15%,是各型颈椎病中一旦诊断明确,多需手术治疗的一类颈椎病。颈椎前路间盘摘除、减压、植骨融合内固定术(Anterior cervical discectomy and fusion,ACDF)已在临床上开展多年,至今仍被大多学者及脊柱外科医生认为是治疗单节段或多节段脊髓型颈椎病前路手术的金标准。目前,在临床上应用最为普及的ACDF术式是椎间融合器(Cage)联合前路钢板(Plate)去完成固定及椎间融合。但长期随访发现,这种方式尤其是由于前方钢板的置入而出现一系列相关并发症:诸如吞咽困难、气管食管损伤、钢板移位、Cage沉降以及邻近节段退变加速等问题。正是为避免以上并发症并尽可能保留颈前路椎间植骨融合固定的优势,Zero-P椎间融合器应运而生。但是在临床疗效方面,已有较多研究表明二者未见显著差异,颈椎病患者术后康复仍是亟待解决的问题。而祖国传统医学中的针灸在康复领域的功效亦越来越受到人们的关注及视。目前尚未见应用传统针灸配合现代新型Zero-P来治疗脊髓型颈椎病以改善临床疗效的报道。目的:1.评估针灸配合Zero-P治疗脊髓型颈椎病临床疗效改善情况;2.评估两种内固定方式后的术后并发症情况,主要关注于术后吞咽困难的发生情况;3.评估与传统的单纯钢板加椎间融合器及单纯Zero-P相比增加针灸治疗有何优势及劣势;方法:选取吉林大学第一医院脊柱外科自2012年12月至2014年4月接受颈椎前路间盘摘除植骨融合内固定术(ACDF)治疗单节段或双节段脊髓型颈椎病患者40例,其中,男性,25(62.5%)例,女性,15(37.5%)例,年龄33~73,平均52.6岁。既往病史26.4个月(6个月-5年)。其中20例应用传统椎间融合器联合钛板内固定系统(Cage+Plate Group,CPG)、20例应用零切迹椎间融合固定系统(Zero-P Group,ZPG)。进一步将将两种固定方式患者进一步随机分为两个亚组,每组10人,一组进行常规术后康复,另一组联合应用针灸康复。共分为四组:单纯Cage+Plate组(CP组),Cage+Plate联合针灸治疗组(Cage+Plate plus Acupuncture Group,CPA组),Zero-P组(ZP组),Zero-P联合针灸治疗组(Zero-P plus Acupuncture Group,ZPA组)。随访时间为1年,统计研究各组患者手术时间、术中出血量、术前术后JOA、NDI、VAS评分、术后吞咽困难评分(Bazaz Yoo Dysphigia Score,BYDS)及其他并发症情况。结果:手术时间:CP组:81.0±25.7min,ZP组:52.5±21.0min,术中出血量:CP组:87.3±34.0ml,ZP组:29.3±13.5ml;术后并发症:CP组:4例吞咽困难,BYDS评估均为中度,1例脑脊液漏,经预防感染、置管减压、加压紧密缝合后痊愈;CPA组:3例吞咽困难,BYDS评估均为中度,ZP组:1例吞咽困难,BYDS评估为轻度,1例脑脊液漏,同上法处理后痊愈;ZPA组:无明确术后并发症;CP组与ZP组间,神经功能评估指数JOA及NDI未见显著性差异(P0.05),术后疼痛VAS评分无显著性差异(P0.05);于术后1个月开始,CPA组神经功能评估指数优于CP组(P0.05),ZPA组神经功能评估指数优于ZP组(P0.05),术后配合进行针灸治疗组(CPA,ZPA)VAS改善情况从术后开始即优于未进行针灸治疗组(CP,ZP)(P0.05)结论:本研究中采用治疗脊髓型颈椎病的两种内固定方式均获得了良好的临床疗效。应用Zero-P系统的手术时间、术中出血量、术后吞咽困难发生率明显低于就用Cage+Plate系统。Cage+Plate系统与Zero-P系统治疗脊髓型颈椎病,神经功能评估指数JOA及NDI未见显著性差异,但配合进行针灸治疗较未进行针灸治疗组JOA、NDI及VAS改善情况优于未进行针灸组,且改善发生时间更早。Zero-P系统治疗脊髓型颈椎病有利于减少手术时间及术中创伤,术后配合针灸治疗有利于患者神经功能的早期改善及缓解疼痛。
[Abstract]:Background: cervical spondylosis is a common and frequently occurring disease that endangering the health of the human body. Cervical spondylotic myelopathy is about 10%-15% of cervical spondylosis. It is a kind of cervical spondylosis that needs surgical treatment once the diagnosis of cervical spondylosis. Cervical anterior intervertebral disc extirpation, decompression, and bone graft fusion (Anterior cervical discectomy and fusion, ACDF) have been found in the cervical spondylosis. Many years of clinical practice have still been considered as the gold standard for the treatment of single segment or multisegmental cervical spondylotic myelopathy by most scholars and spinal surgeons. Currently, the most widely used ACDF method is the intervertebral fusion (Cage) combined anterior plate (Plate) to complete the fixation and intervertebral fusion. This approach is especially due to a series of related complications, such as dysphagia, tracheoesophageal injury, plate displacement, Cage subsidence, and acceleration of adjacent segmental degeneration, which is the advantage of avoiding the above complications and preserving the anterior cervical interbody fusion fixation as far as possible, and the Zero-P interbody fusion device should But in the clinical effect, there have been many studies showing that there is no significant difference between the two. The rehabilitation of the patients with cervical spondylosis is still a problem to be solved urgently. The effect of acupuncture and moxibustion in the rehabilitation field in the traditional medicine of the motherland is also paid more and more attention. At present, the traditional acupuncture and moxibustion have not been seen with modern new Zero-P. Treatment of cervical spondylotic myelopathy in order to improve clinical efficacy. Objective: 1. evaluate the clinical efficacy of acupuncture and moxibustion combined with Zero-P in the treatment of cervical spondylotic myelopathy; 2. evaluate the postoperative complications after two internal fixation, mainly concerned with the occurrence of postoperative dysphagia; 3. assessment and traditional simple plate plus interbody fusion and single The advantages and disadvantages of pure Zero-P were compared with that of increasing acupuncture and moxibustion. Methods: 40 cases of single segment or double segmental spondylotic myelopathy were selected from December 2012 to April 2014 in No.1 Hospital of Jilin University spinal surgery, including 25 (62.5%), 25 (62.5%) cases, 15 (37.5%) cases, and 40 cases of cervical spondylotic myelopathy. Age 33~73, an average of 52.6 years, has a history of 26.4 months (6 months -5). Of them, 20 cases were combined with Cage+Plate Group (CPG), and 20 cases of Zero-P Group, ZPG. Further, two fixed patients were further divided into two subgroups, 10 in each group. One group was divided into four groups: simple Cage+Plate group (group CP), Cage+Plate combined acupuncture and moxibustion treatment group (Cage+Plate plus Acupuncture Group, CPA group), Zero-P group (ZP group), Zero-P combined acupuncture treatment group. The follow-up time was 1 years. Operation time, intraoperative bleeding, preoperative JOA, NDI, VAS score, postoperative dysphagia score (Bazaz Yoo Dysphigia Score, BYDS) and other complications. Results: operation time: CP group: 81 + 25.7min, ZP group: 52.5 + 21.0min, bleeding volume: 87.3 + 29.3; postoperative complications: 4 cases of swallowing Difficulties, BYDS assessment was moderate, 1 cases of cerebrospinal fluid leakage, the prevention of infection, intubation decompression, tight suture recovery after compression; group CPA: 3 cases of dysphagia, BYDS assessment is moderate, group ZP: 1 cases of dysphagia, BYDS evaluation is mild, 1 cases of cerebrospinal fluid leakage, after the same method after treatment, no clear postoperative complications; CP group and ZP group, nerve function between group and group. There was no significant difference in the evaluation index JOA and NDI (P0.05), and there was no significant difference in postoperative pain VAS score (P0.05). At 1 months after the operation, the evaluation index of nerve function in group CPA was superior to that of group CP (P0.05), and the evaluation index of nervous function in group ZPA was superior to that of ZP group (P0.05). No acupuncture treatment group (CP, ZP) (P0.05) conclusion: in this study, two internal fixation methods for the treatment of cervical spondylotic myelopathy have achieved good clinical efficacy. The operation time of the Zero-P system, the amount of intraoperative bleeding, and the incidence of dysphagia after operation are significantly lower than that of the Cage+Plate system.Cage+Plate system and the Zero-P system. There was no significant difference in nerve function evaluation index JOA and NDI, but the combination of acupuncture and moxibustion treatment was better than that of non acupuncture treatment group JOA, NDI and VAS improved better than without acupuncture and moxibustion, and the improvement of early.Zero-P system for the treatment of cervical spondylotic myelopathy was beneficial to reduce operation time and intraoperative trauma and postoperative coordination needles. Moxibustion treatment is conducive to early improvement of neurological function and relieving pain.
【学位授予单位】：长春中医药大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3

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