饶敏杰,严 宁,侯铁胜,张功恒,甘心荣,徐文华,曹盛生.颈前路手术治疗4个节段脊髓型颈椎病的中期疗效分析[J].中国脊柱脊髓杂志,2020,(4):346-352. |
颈前路手术治疗4个节段脊髓型颈椎病的中期疗效分析 |
中文关键词: 颈前路手术 脊髓型颈椎病 中期疗效 手术并发症 |
中文摘要: |
【摘要】 目的:探讨颈前路手术治疗4个节段脊髓型颈椎病的中期临床效果及其并发症分析。方法:回顾性分析2013年9月~2016年10月,行颈椎前路手术治疗的4个节段脊髓型颈椎病31例患者资料,男18例,女13例,年龄54~74岁,平均58.1±4.9岁,对所有患者进行随访,采用疼痛视觉模拟评分(visual analogue scale,VAS)评估颈肩肢体疼痛情况,日本骨科协会(Japanese Orthopedic Association,JOA)评分评估患者神经功能恢复情况,行颈椎正侧位及过伸过屈位X线片,观察钛网等内固定情况,测量C2~C7颈椎椎体高度和颈椎生理曲度,评估植骨融合情况。并记录患者手术相关并发症。结果:27例患者获得随访,随访时间为35~72个月,平均52.7±3.6个月。末次随访时VAS为1.6±0.6分,低于术前的7.2±1.5分,差异有统计学意义(P<0.001)。末次随访JOA评分为16.1±4.2分,高于术前的8.8±3.7分,差异有统计学意义(P<0.001)。至末次随访时,患者颈椎椎体高度及颈椎曲度较术前均有明显改善,差异有统计学意义(P<0.001)。所有患者均获得骨性融合,27例患者共出现19例次并发症,脑脊液漏3例,一过性吞咽困难2例,轴性症状1例,C5神经根麻痹2例,邻近节段退变6例,钛网下沉2例,内固定松动、移位2例,螺钉断裂1例。结论:颈前路手术治疗脊髓前方受压为主的4个节段脊髓型颈椎病,能有效恢复颈椎高度和维持颈椎曲度,其中期疗效满意。 |
The mid-term clinical outcome of anterior surgical in the treatment of 4-level cervical spondylotic myelopathy |
英文关键词:Anterior cervical surgery Cervical spondylotic myelopathy Postoperative complications Mid-term clinical effects |
英文摘要: |
【Abstract】 Objectives: To investigate the mid-term clinical results and the complications of patients with 4-level cervical spondylotic myelopathy who underwent anterior decompression and fusion surgery. Methods: Between September 2013 and October 2016, 31 patients of 4-level cervical spondylotic myelopathy who underwent anterior cervical surgery were included. There were 18 males and 13 females, whose mean age was 58.1±4.9 years old(range, 54-74 years). The neck and shoulder pain were evaluated by visual analogue scale(VAS), and neurological function measured using Japanese Orthopedic Association(JOA) scores. X-rays were conducted before and after surgery for cervical height, physiological curvature of C2-C7 and fusion rate. Complications of the patients were recorded and analyzed as well. Results: 27 cases completed the follow-up. The mean follow-up time was 52.7±3.6 months(35-72 months). At final follow-up, the VAS scores reduced from preoperative 7.2±1.5 points to 1.6±0.6 points(P<0.001), and the JOA scores increased from preoperative 8.8±3.7 points to 16.1±4.2 points(P<0.001). At final follow-up, the cervical height and physiological curvature showed significant improvement compared with pre-operation(P<0.001). The fusion rate was 100%. 15 patients presented with related complications, including 3 cases of cerebral fluid leakage, 2 cases of temporary dysphagia, 1 cases of axial neck pain, 4 cases of C5 palsy, 6 cases of adjacent segment diseases, 2 cases of graft subsidence, 2 cases of looseness and displace of the internal fixation and 1 case of screw extraction. Conclusions: Anterior cervical surgery for 4-level cervical spondylotic myelopathy is a challenging surgical technique, restoring the height of cervical vertebra and the curvature of cervical vertebra, with good results for the mid-term efficacy of clinical effects. |
投稿时间:2019-09-15 修订日期:2019-12-06 |
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