空心钉置入椎管重建术治疗多节段脊髓型颈椎病

发布时间：2018-07-10 15:13

本文选题：脊髓型颈椎病 + 单开门椎管成形术　；参考：《中国矫形外科杂志》2017年11期

【摘要】：[目的]探讨在多节段脊髓型颈椎病后路单开门椎管扩大成形术中应用空心钉重建颈椎管的临床疗效。[方法]2012年2月~2015年10月,对42例多节段脊髓型颈椎病患者行颈椎后路单开门椎管扩大减压术,术中采用空心钉置入重建椎管。其中34例患者获得随访,男21例,女13例,年龄48~72岁,平均63岁。评估手术时间、术中出血量,观察术中和术后并发症发生情况;所有随访的患者均行CT和MRI检查,比较术前及末次随访的JOA评分以及C_5椎管横截面积。[结果]手术时间(135±32)min,术中出血量为(230±46)ml,术中未出现脊髓损伤、脑脊液漏等相关并发症;随访10~28个月,平均14.2个月,影像学评估显示植骨处达骨性愈合,未见空心钉脱落移位及再关门现象。神经功能明显改善,JOA从术前(7.23±2.56)分提高至(13.71±2.40)分,差异有统计学意义(P0.01),改善率为(69.16±18.21)%;末次随访时C_5椎管横截面积均显著优于治疗前(P0.01)。[结论]空心钉置入颈椎管重建术可明显改善多节段脊髓型颈椎病患者的神经功能,临床疗效满意;且操作技术安全,可提供即刻的力学支持,提高截骨处的愈合率,可作为多节段脊髓型颈椎病一种手术方式的选择。
[Abstract]:[objective] to investigate the clinical effect of reconstructing cervical spinal canal with hollow nail in multilevel cervical Spondylotic disease. [methods] from February 2012 to October 2015, 42 patients with multilevel cervical Spondylotic myelopathy were treated with open door spinal canal decompression via posterior approach. Among them, 34 cases were followed up, including 21 males and 13 females, aged 4872 years with an average age of 63 years. All patients were examined with CT and MRI to compare the JOA score and the cross-sectional area of C5 spinal canal between preoperative and last follow-up. [results] the operative time was (135 卤32) min, the intraoperative blood loss was (230 卤46) ml, and there were no related complications such as spinal cord injury and cerebrospinal fluid leakage during the operation. There was no phenomenon of hollow nail shedding and reclosing. JOA was significantly improved from (7.23 卤2.56) to (13.71 卤2.40), the difference was statistically significant (P0.01), the improvement rate was (69.16 卤18.21), and the cross-sectional area of C5 spinal canal at the last follow-up was significantly better than that before treatment (P0.01). [conclusion] the reconstruction of cervical spinal canal with hollow nail can obviously improve the nerve function of patients with multilevel cervical Spondylotic myelopathy, and the clinical effect is satisfactory, and the operation technique is safe, which can provide immediate mechanical support and improve the healing rate of osteotomy. It can be used as a choice of multilevel cervical Spondylotic myelopathy.
【作者单位】：福建省南平市福建医科大学附属南平市第一医院脊柱外科;
【基金】：福建省南平市科技基金项目(编号:N2015Y03)
【分类号】：R687.3

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