颈后路单开门椎管扩大成形术曲度变化与轴性症状的相关研究

发布时间：2018-09-10 21:31

【摘要】：目的:探讨颈后路单开门椎管扩大成形术后曲度变化与神经功能改善、疼痛症状缓解、轴性症状发生率的关系及临床意义。方法:回顾我院2011年1月~2015年12月收治的多节段脊髓型颈椎病(cervical spondylotic myelopathy,CMS)患者55例,分为两组并分别用两种手术方式行颈后路单开门椎管扩大成形术。A组行传统丝线悬吊法颈后路单开门椎管扩大成形术23例,男性15例,女性8例,平均57.1岁(42-75岁)。B组行微型钛板固定法椎管成形术32例,男性21例,女性11例,平均56.6岁(47-68岁)。对两组患者术前及术后进行JOA评分(Japanese Orthopaedic Association Scores)并计算神经功能恢复率,手术前后行VAS评分(visual analogue scale)评估患者手术前后疼痛恢复情况,通过手术前后颈椎X线检查,测量并计算颈椎曲度指数CCI(cervical curvature index)的丢失,随访两组患者术后轴性症状的严重程度并计算其发病率,对以上所得数据进行统计学分析。结果:两组术后均获得随访,时间为15-39个月,平均18个月。两组患者神经功能与术前比较均获得明显改善,JOA评分恢复率,A组患者为(60.2±15.2)%,B组患者为(62.8±13.4)%,但两组差异无统计学意义。两组患者术后疼痛均得到缓解,VAS评分,A组为(2.14±1.78),B组为(2.55±1.33),差异有统计学意义。两组患者术后颈椎曲度都有不同程度的丢失,A组患者丢失指数为(4.5±2.5)%,B组患者为(2.8±2.5)%,两组差异有统计学意义,且A组曲度丢失明显大于B组。轴性症状发病率,A组为39.13%,B组为18.75%,差异有统计学意义,且A组高于B组。结论:1.微型钛板固定法颈后路单开门椎管扩大成形术和传统丝线悬吊法椎管成形术治疗多节段脊髓型颈椎病,都能得到很好的神经功能改善。2.相比传统丝线悬吊法椎管成形术,微型钛板固定法颈后路单开门椎管扩大成形术对颈椎稳定性效果更好,可减少颈椎曲度的丢失。3.颈椎生理曲度的丢失与轴性症状的发病率有一定的相关性,防止颈椎生理曲度的丢失,能有效防止轴性症状的发生。
[Abstract]:Objective: to investigate the relationship between the changes of curvature and the improvement of nerve function, the relief of pain symptoms, and the incidence of axial symptoms in posterior cervical open door laminoplasty. Methods: from January 2011 to December 2015, 55 patients with multilevel cervical Spondylotic myelopathy (cervical spondylotic myelopathy,CMS) were retrospectively reviewed. Two groups were divided into two groups, 23 cases were treated with traditional filament-suspension single open door laminoplasty, 15 cases were males and 8 cases were females. The mean age was 57.1 years (42-75 years). Group B was treated with mini-titanium plate fixation in 32 cases, male 21 cases, female 11 cases, mean 56.6 years (47-68 years). Before and after operation, JOA score (Japanese Orthopaedic Association Scores) and neural function recovery rate were calculated, VAS score (visual analogue scale) was used before and after operation to evaluate the pain recovery of patients before and after operation, and the cervical spine X-ray was performed before and after operation. The loss of cervical curvature index (CCI (cervical curvature index) was measured and calculated. The severity and incidence of axial symptoms were measured and calculated. The above data were analyzed statistically. Results: both groups were followed up for 15-39 months (mean 18 months). The recovery rate of JOA score in group A was (60.2 卤15.2) and (62.8 卤13.4) in group B, but there was no significant difference between the two groups. The VAS score of group A was (2.14 卤1.78) and group B was (2.55 卤1.33), the difference was statistically significant. The loss index of cervical curvature in group A was (4.5 卤2.5) and that in group B was (2.8 卤2.5), the difference was statistically significant, and the loss of curvature in group A was significantly higher than that in group B. The incidence of axial symptoms was higher in group A than in group B (39.13% vs 18.75%), and higher in group A than in group B. Conclusion 1. The treatment of multilevel cervical Spondylotic myelopathy with mini-titanium plate fixation with single open door laminoplasty and traditional filament-suspension laminoplasty can improve the neurologic function of patients with cervical Spondylotic myelopathy. Compared with the traditional filament-suspension laminoplasty, the micro-titanium plate fixation single open door laminoplasty has better effect on the stability of the cervical spine, and can reduce the loss of cervical curvature by .3. There is a certain correlation between the loss of physiological curvature of cervical vertebrae and the incidence of axial symptoms. Preventing the loss of physiological curvature of cervical vertebrae can effectively prevent the occurrence of axial symptoms.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

【参考文献】