颈后路椎管扩大成形术后后凸畸形的研究进展

发布时间：2018-08-06 11:50

【摘要】：近年来,颈椎病的发生率逐渐升高,在各种类型颈椎病中,尤其以脊髓型颈椎病的危害最大。因为颈椎间盘的退变,导致颈部脊髓受到压迫,引起神经功能的损害,严重影响患者的生活质量。目前,手术治疗是脊髓型颈椎病的主要治疗手段。手术方式包括颈椎前路椎间盘切除植骨融合内固定术、颈椎前路椎体次全切除融合术、颈后路椎管扩大成形术、以及前后路联合手术。对于短节段受压的脊髓型颈椎病,大多数骨科医生采用经前路减压植骨融合固定术。然而,对于多节段受压的脊髓型颈椎病,最佳的手术治疗方式的选择仍然存在着争议。每种手术方式都有各自的优缺点。其中,颈后路椎管扩大成形术是治疗多节段颈髓受压颈椎病的一种效果良好并且常用的手术方式。大部分学者认为,在行手术前,颈椎要有前凸的曲度,才能保证术后脊髓向后漂移,达到神经压迫解除的效果。然而,很多接受此手术治疗的患者,术后出现了颈椎后凸畸形,并且严重影响了患者术后生活的质量。目前,对于术后颈椎后凸畸形的发生机制并无统一定论。通过查阅有关手术后颈椎后凸畸形的文献,就其相关因素和预防措施的研究进展综述如下,以便更好的指导临床工作,提高手术疗效。通过总结相关文献,颈后路椎管扩大成形术后引起颈椎后凸畸形的相关危险因素有:高年龄患者,手术前颈椎曲度不佳,不恰当的手术方式,手术后颈椎失稳、颈椎后方肌肉韧带复合体及其骨骼附着点的破坏,以及术后未进行正规的功能锻炼。因此,在手术前、手术中和手术后避免上述相关危险因素,可明显的减少手术后颈椎后凸畸形的发生概率。
[Abstract]:In recent years, the incidence of cervical spondylopathy has gradually increased. Among all types of cervical spondylosis, especially the cervical Spondylotic myelopathy is the most harmful. Because of the degeneration of cervical intervertebral disc, the cervical spinal cord is compressed, the nerve function is damaged, and the patient's quality of life is seriously affected. At present, surgical treatment is the main treatment of cervical Spondylotic myelopathy. The surgical methods include anterior intervertebral disc resection, bone grafting and internal fixation, anterior subtotal vertebral body resection and fusion, posterior cervical spinal canal angioplasty, and combined anterior and posterior approach. For short segment compression cervical Spondylotic myelopathy, most orthopedic surgeons use anterior decompression and fusion fixation. However, the choice of optimal surgical treatment for multilevel compression cervical Spondylotic myelopathy remains controversial. Each operation has its own advantages and disadvantages. The extended posterior cervical canal angioplasty is an effective and commonly used method for the treatment of multilevel cervical spinal cord compression. Most scholars believe that before surgery, the cervical spine should have convex curvature to ensure the spinal cord drift backward and relieve the nerve compression. However, cervical kyphosis was found in many patients who received the operation, which seriously affected the quality of life. At present, there is no unified conclusion on the mechanism of postoperative cervical kyphosis. By consulting the literature about cervical kyphosis after operation, the research progress of its related factors and preventive measures is summarized below, in order to better guide clinical work and improve the curative effect of operation. By summarizing the relevant literature, the related risk factors of cervical kyphosis after posterior cervical spinal canal dilatation are as follows: older patients, poor cervical curvature before operation, inappropriate surgical methods, post-operative instability of the cervical spine. The destruction of posterior musculoligamentous complex and its bone attachment, and no regular functional exercise after operation. Therefore, avoiding these risk factors before, during and after surgery can significantly reduce the probability of cervical kyphosis.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

【参考文献】