颈前路椎体次全切术治疗节段型颈椎后纵韧带骨化症临床疗效分析

发布时间：2018-09-03 10:07

【摘要】：目的:通过临床观察与病例随访,评价和分析颈前路椎体次全切术治疗节段型颈椎后纵韧带骨化症临床疗效及其影响因素。并进一步探讨颈椎后纵韧带的认识过程、发病机制、手术治疗方式及前路手术的优势,为节段型颈椎后纵韧带骨化症的临床治疗提供客观依据。方法:通过回顾分析自2010年10月至2015年3月在山东中医药大学附属医院脊柱骨科收治的37例行颈前路手术治疗的节段型颈椎后纵韧带骨化症患者病历及随访资料,采用日本骨科学会JOA评分系统评估手术疗效。根据可能对手术疗效有影响的若干因素,如:病程、椎管侵占率等,对手术疗效进行统计学分析,并评估各因素对手术疗效的影响。结果:患者JOA评分由术前(10.30±1.54)提高到(14.81±1.15),经统计学检验p0.01,根据平林冽法评定患者末次随访神经功能改善率,其总体优良率91%,末次随访改善率(66.33±13.24)%,手术疗效满意。统计学分析显示,患者病程(p0.05)、脊髓信号(p0.01)、椎管侵占率(p0.05)、骨化物形态(p0.05)与手术疗效相关,而外伤史在早期随访(p0.05)与手术疗效相关,末次随访(p0.05)不具有统计学意义。结论:颈前路椎体次全切术治疗节段型颈椎OPLL疗效确切,其直接解除骨化物对脊髓压迫,达到即时稳固,有效恢复颈椎生理曲度,具有直接、有效、彻底的特点,长期随访满意。椎管侵占率、脊髓信号、病程、骨化物形态均会对手术疗效产生不同程度的影响,外伤史在早期对手术疗效有影响但随访末期未见影响。
[Abstract]:Objective: to evaluate and analyze the clinical effect and influencing factors of subtotal cervical vertebra resection in the treatment of ossification of cervical posterior longitudinal ligament by clinical observation and follow-up. The understanding process, pathogenesis, surgical treatment and advantages of anterior approach of cervical posterior longitudinal ligament were further discussed, which provided objective basis for clinical treatment of cervical posterior longitudinal ligament ossification. Methods: from October 2010 to March 2015, 37 cases of cervical posterior longitudinal ligament ossification treated by anterior cervical approach in the Department of Spinal Orthopaedics, affiliated Hospital of Shandong University of traditional Chinese Medicine, were retrospectively analyzed. The JOA scoring system of Japanese Orthopaedics Association was used to evaluate the outcome of the operation. According to several factors that may influence the curative effect of surgery, such as course of disease, spinal canal invasion rate and so on, the effect of operation is analyzed statistically, and the influence of each factor on the curative effect of operation is evaluated. Results: the JOA score of the patients was increased from (10.30 卤1.54) to (14.81 卤1.15). The improvement rate of nerve function was evaluated according to the method of Pinglinlie. The overall excellent and good rate was 91 and the improvement rate of the last follow-up was 66.33 卤13.24. The operative effect was satisfactory. Statistical analysis showed that the course of disease (p0.05), spinal cord signal (p0.01), spinal canal invasion rate (p0.05), ossification morphology (p0.05) were correlated with the operative effect, but the history of trauma was correlated with the operative effect in the early follow-up (p0.05), but the last follow-up (p0.05) had no statistical significance. Conclusion: anterior cervical subtotal vertebra resection is effective in the treatment of segmental cervical OPLL. It can relieve the ossification directly from spinal cord compression, achieve immediate stability, and effectively restore the physiological curvature of cervical vertebrae. It has the characteristics of direct, effective and thorough. Long-term follow-up was satisfactory. The spinal canal invasion rate, spinal cord signal, course of disease and ossification morphology all had different effects on the operative effect. The traumatic history had influence on the surgical effect at the early stage but not at the end of follow-up.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R687.3

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