颈前路椎间盘切除植骨融合术治疗多节段颈椎病中应用限制性钢板与非限制性钢板对手术后颈椎生理曲度丢失率的比较
发布时间：2018-12-31 08:28
【摘要】：目的:探讨在ACDF治疗多节段颈椎病中应用限制性钢板与非限制性钢板对手术后颈椎曲度弧度丢失率的比较方法:收集2011年2月至2013年12月在我科行颈前路椎间隙减压手术治疗的多节段颈椎病患者67例。其中男38例,女29例,年龄41-69岁,平均年龄51岁。随机分成A、B两组,A组两节段的29例,三节段的6例;术中使用限制性钢板,B组两节段的25例,三节段的8例,术中使用非限制性钢板。收集所有患者手术前、手术后1个月、半年、1年随访的颈椎侧位片及评估JOA评分。所有数据采用SPSS19.0软件进行组内配对t检验及组间χ2检验分析,以P0.05定为差异有统计学意义。结果:所有患者均获得完整随访资料,所有患者均于术后3-4天出院,随访时间12-18个月,平均14.2个月。两组患者术后椎间植骨融合率为100%,所有患者均未出现螺钉脱出,钢板移位或断裂现象。两组患者手术后神经功能较术前均有明显改善,A组JOA评分由术前(8.7±1.4)分提升至(14.7±1.2)分,B组由术前的(8.6±1.5)分提升至(14.1±1.5)分;术后1年随访JOA改善率:A组为74.43%,B组为68.75%;两组间各时期JOA评分无明显统计学差异。两组患者手术后颈椎生理曲度较术前均有改善,但两组之间无统计学差异。A组两节段颈椎病患者手术后1年颈椎生理曲度丢失率为(1.33±0.28)°,三节段颈椎病患者丢失率为(5.42±1.68)°;B组两节段颈椎病患者丢失率为(1.48±0.31)°,三节段颈椎病患者丢失率(5.53±1.71)°;两组患者丢失率无明显统计学差异,A组颈椎生理曲度丢失率总体均数稍低于B组。两组患者手术后椎间高度较术前均有改善,A组两节段颈椎病患者手术后1年的椎间高度丢失量为(1.81±0.47)mm,三节段患者丢失量为(2.17±0.61)mm;B组两节段颈椎病患者丢失量为(2.62±0.46)mm,三节段患者丢失量为(2.93±0.37)mm;两组患者椎间高度丢失量在统计上无明显差异,但A组椎间高度总体丢失量均数低于B组。A组术后颈部轴性症状发生率为5.07%,B组的发生率为12.50%;两组颈部轴性症状发生率无统计学差异,A组颈部轴性症状发生率总体低于B组。结论:1.ACDF在治疗多节段颈椎病患者时,结合限制性钢板或非限制性钢板均可获得满意的临床疗效。2.在术后维持颈椎生理曲度、椎间高度及减少颈部轴性症状发生率方面限制性钢板稍优于非限制性钢板。
[Abstract]:Objective: to investigate the comparison of the loss rate of curvature of cervical spine with restriction plate and unconstrained plate in the treatment of multilevel cervical spondylosis by ACDF: to collect the anterior cervical intervertebral space from February 2011 to December 2013 in our department. 67 patients with multilevel cervical spondylosis treated by decompression surgery. There were 38 males and 29 females, aged 41-69 years, with an average age of 51 years. They were randomly divided into two groups: 29 cases in group A, 6 cases in three segments, 25 cases in group B, 25 cases in group B and 8 cases in three segments. All patients were followed up for 1 month, 1 month, 6 months and 1 year after operation and JOA score was evaluated. All data were analyzed by intra-group paired t-test and 蠂 ~ 2 test with SPSS19.0 software. Results: all the patients received complete follow-up data. All patients were discharged from hospital 3-4 days after operation for 12-18 months with an average of 14. 2 months. The fusion rate of intervertebral bone graft was 100% in both groups. No screw protrusion, plate displacement or fracture were found in all the patients. The neurological function in group A was improved from (8.7 卤1. 4) to (14. 7 卤1. 2) in group A and from (8.6 卤1. 5) in group B to (14. 1 卤1. 5) in group B. The improvement rate of JOA in group A was 74.43 and that in group B was 68.750.There was no significant difference in JOA score between the two groups. There was no statistical difference between the two groups. The loss rate of physiological curvature of cervical spine in group A was (1.33 卤0.28) 掳1 year after operation. The loss rate of patients with three-segment cervical spondylosis was (5.42 卤1.68) 掳. In group B, the loss rate was (1.48 卤0.31) 掳in patients with two-segment cervical spondylosis and (5.53 卤1.71) 掳in patients with three-segment cervical spondylosis. There was no significant difference in the loss rate between the two groups, and the total mean loss rate of cervical vertebra physiological curvature in group A was slightly lower than that in group B. The loss of intervertebral height in group A was (1. 81 卤0. 47) mm, and (2. 17 卤0. 61) mm;. The loss of two segments of cervical spondylopathy in group B was (2.62 卤0.46) mm, and the amount of loss in three-segment patients was (2.93 卤0.37) mm;. There was no statistical difference in the loss of intervertebral height between the two groups, but the average of total loss of intervertebral height in group A was lower than that in group B. the incidence of cervical axial symptoms in group A was 5.07 and 12.50 respectively. The incidence of cervical axial symptoms in group A was lower than that in group B. Conclusion: when 1.ACDF is used in the treatment of multilevel cervical spondylopathy, the combination of restricted plate and unconstrained plate can obtain satisfactory clinical curative effect. 2. The restrictive plate was superior to the unconstrained plate in maintaining the physiological curvature of cervical spine, intervertebral height and reducing the incidence of cervical axial symptoms.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
本文编号：2396326
[Abstract]:Objective: to investigate the comparison of the loss rate of curvature of cervical spine with restriction plate and unconstrained plate in the treatment of multilevel cervical spondylosis by ACDF: to collect the anterior cervical intervertebral space from February 2011 to December 2013 in our department. 67 patients with multilevel cervical spondylosis treated by decompression surgery. There were 38 males and 29 females, aged 41-69 years, with an average age of 51 years. They were randomly divided into two groups: 29 cases in group A, 6 cases in three segments, 25 cases in group B, 25 cases in group B and 8 cases in three segments. All patients were followed up for 1 month, 1 month, 6 months and 1 year after operation and JOA score was evaluated. All data were analyzed by intra-group paired t-test and 蠂 ~ 2 test with SPSS19.0 software. Results: all the patients received complete follow-up data. All patients were discharged from hospital 3-4 days after operation for 12-18 months with an average of 14. 2 months. The fusion rate of intervertebral bone graft was 100% in both groups. No screw protrusion, plate displacement or fracture were found in all the patients. The neurological function in group A was improved from (8.7 卤1. 4) to (14. 7 卤1. 2) in group A and from (8.6 卤1. 5) in group B to (14. 1 卤1. 5) in group B. The improvement rate of JOA in group A was 74.43 and that in group B was 68.750.There was no significant difference in JOA score between the two groups. There was no statistical difference between the two groups. The loss rate of physiological curvature of cervical spine in group A was (1.33 卤0.28) 掳1 year after operation. The loss rate of patients with three-segment cervical spondylosis was (5.42 卤1.68) 掳. In group B, the loss rate was (1.48 卤0.31) 掳in patients with two-segment cervical spondylosis and (5.53 卤1.71) 掳in patients with three-segment cervical spondylosis. There was no significant difference in the loss rate between the two groups, and the total mean loss rate of cervical vertebra physiological curvature in group A was slightly lower than that in group B. The loss of intervertebral height in group A was (1. 81 卤0. 47) mm, and (2. 17 卤0. 61) mm;. The loss of two segments of cervical spondylopathy in group B was (2.62 卤0.46) mm, and the amount of loss in three-segment patients was (2.93 卤0.37) mm;. There was no statistical difference in the loss of intervertebral height between the two groups, but the average of total loss of intervertebral height in group A was lower than that in group B. the incidence of cervical axial symptoms in group A was 5.07 and 12.50 respectively. The incidence of cervical axial symptoms in group A was lower than that in group B. Conclusion: when 1.ACDF is used in the treatment of multilevel cervical spondylopathy, the combination of restricted plate and unconstrained plate can obtain satisfactory clinical curative effect. 2. The restrictive plate was superior to the unconstrained plate in maintaining the physiological curvature of cervical spine, intervertebral height and reducing the incidence of cervical axial symptoms.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.3
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