改良单开门椎管扩大成形治疗慢性压迫性颈脊髓病

发布时间：2018-11-07 19:50

【摘要】：目的：验证改良单开门椎管扩大成形治疗慢性压迫性颈脊髓病的临床效果。方法：回顾性分析2010年1月至2013年12月在新疆医科大学第一附属医院行后路单开门椎管扩大成形治疗的慢性压迫性颈脊髓病患者87例,其中改良组41例采用改良单开门椎管扩大成形治疗,保留C7棘突及其附着肌肉韧带组织,开门节段为C3-C6；对照组46例采用传统C3-C7单开门扩大成形治疗。记录手术时间、术中出血量,对两组患者治疗前及治疗后随访时的JOA评分(17分法)、颈椎曲度Cobb角、颈椎活动度及轴性症状严重程度等进行对比分析。结果：87例患者全部获得随访,改良组手术时间(82.46±14.80)min,出血量(196.3±141.4)mL；对照组手术时间(78.41±15.43)min,出血量(220.91±128.21)mL,两组差异无显著性意义(P0.05)。JOA评分恢复率两组差异无显著性意义(P0.05)。改良组治疗后有明显轴性症状患者的比例为17%,对照组为46%,对照组显著高于改良组(P0.05)。改良组治疗后颈椎曲度丢失程度、颈椎活动度丢失程度均显著小于对照组(P0.05)。两组末次随访门轴侧均骨性愈合,无椎板塌陷和再“关门”现象。结论：改良单开门椎管扩大成形治疗能获得良好的神经减压效果,同时可以最大程度维持颈后韧带复合体结构和功能的完整性,减少对颈椎稳定机制的破坏,从而保留颈椎曲度、颈椎活动度,并降低术后轴性症状的发生。
[Abstract]:Objective: to verify the clinical effect of modified open-door spinal canal enlargement in the treatment of chronic compressive cervical myelopathy. Methods: from January 2010 to December 2013, 87 patients with chronic compression cervical myelopathy were treated by posterior open-door spinal canal reconstruction in the first affiliated Hospital of Xinjiang Medical University. In the modified group, 41 cases were treated with modified single-door laminoplasty, the C7 spinous process and its attached muscle ligament tissue were preserved, and the open door segment was C3-C6. The control group (46 cases) was treated with conventional C3-C7 open door expanded plastic therapy. The operation time, intraoperative bleeding volume, JOA score (17 points), Cobb angle of cervical curvature, cervical motion and severity of axial symptoms were compared and analyzed before and after treatment in the two groups. Results: all 87 patients were followed up. The operative time of the modified group was (82.46 卤14.80) min, bleeding volume (196.3 卤141.4) mL;. The operative time of the control group was (78.41 卤15.43) min, bleeding volume (220.91 卤128.21) mL, there was no significant difference between the two groups (P0.05). JOA score recovery rate (P0.05). The proportion of patients with obvious axial symptoms after treatment was 17 in the modified group, 46 in the control group, and significantly higher in the control group than in the modified group (P0.05). The degree of cervical curvature loss and cervical motion loss in the modified group were significantly lower than those in the control group (P0.05). In the last follow-up, bony healing was found in both groups, without laminar collapse and reclosing. Conclusion: the modified open door laminoplasty can obtain good neurodecompression effect, at the same time, it can maintain the integrity of the structure and function of the complex of posterior cervical ligament to the maximum extent, and reduce the destruction of the stability mechanism of cervical spine. Thus preserving cervical curvature, cervical motion, and reducing the incidence of postoperative axial symptoms.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
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本文编号：2317399