CAJ | 학술논문

目的探讨应用锚定板自锁式颈椎间融合器治疗多节段脊髓型颈椎病的临床疗效.方法 2008年4月至2010年3月对45例多节段脊髓型颈椎病患者行颈前路椎间盘切除减压、自锁式椎间融合器植骨融合内固定手术治疗,其中男性23例,女性22例,年龄32 ～ 67岁,平均53岁.术前及术后3d、3、6个月及此后每年进行随访,记录日本骨科学会(JOA)评分,评估神经功能恢复情况；记录术前及末次随访时SF-36健康调查评分评估临床疗效；行颈椎侧位X线片观察椎间高度、颈椎整体曲度及植骨融合情况,采用重复测量方差分析进行数据统计.结果患者随访24 ～ 35个月,平均28.4个月.所有患者的神经功能都有显著的恢复,JOA评分由术前平均(6.5±3.1)分升至术后平均(13.4±1.7)分,差异有统计学意义(F=17.84,P=0.001)；SF-36健康调查评分除心理健康外的7个维度较术前均有显著改善(t=1.151 ～ 12.207,P ＜0.05),优良率为91.1％.椎间隙高度由术前平均(5.5±1.8) mm,至末次随访时平均(8.3±0.8) mm,差异有统计学意义(F=11.71,P=0.043);颈椎整体曲度由术前平均5°±7°,至末次随访时平均为10°±14°,差异有统计学意义(F =234.53,P=0.000).1例患者出现髂骨取骨区切口脂肪液化；1例患者出现髂骨取骨处血肿,经治疗后痊愈,未见其他手术相关并发症发生.术后复查X线片证实,45例患者111个融合节段均获骨性融合,融合率100％.结论锚定板自锁式颈椎间融合器应用于多节段脊髓型颈椎病的治疗,临床效果满意、植骨融合率高、手术创伤小,能有效恢复椎间隙高度和颈椎生理弧度.
목적 탐토응용묘정판자쇄식경추간융합기치료다절단척수형경추병적림상료효.방법 2008년4월지2010년3월대45례다절단척수형경추병환자행경전로추간반절제감압、자쇄식추간융합기식골융합내고정수술치료,기중남성23례,녀성22례,년령32 ～ 67세,평균53세.술전급술후3d、3、6개월급차후매년진행수방,기록일본골과학회(JOA)평분,평고신경공능회복정황；기록술전급말차수방시SF-36건강조사평분평고림상료효；행경추측위X선편관찰추간고도、경추정체곡도급식골융합정황,채용중복측량방차분석진행수거통계.결과 환자수방24 ～ 35개월,평균28.4개월.소유환자적신경공능도유현저적회복,JOA평분유술전평균(6.5±3.1)분승지술후평균(13.4±1.7)분,차이유통계학의의(F=17.84,P=0.001)；SF-36건강조사평분제심리건강외적7개유도교술전균유현저개선(t=1.151 ～ 12.207,P ＜0.05),우량솔위91.1％.추간극고도유술전평균(5.5±1.8) mm,지말차수방시평균(8.3±0.8) mm,차이유통계학의의(F=11.71,P=0.043);경추정체곡도유술전평균5°±7°,지말차수방시평균위10°±14°,차이유통계학의의(F =234.53,P=0.000).1례환자출현가골취골구절구지방액화；1례환자출현가골취골처혈종,경치료후전유,미견기타수술상관병발증발생.술후복사X선편증실,45례환자111개융합절단균획골성융합,융합솔100％.결론 묘정판자쇄식경추간융합기응용우다절단척수형경추병적치료,림상효과만의、식골융합솔고、수술창상소,능유효회복추간극고도화경추생리호도.
Objective To investigate the use of anterior cervical discotomy and fusion with selflocking cages to treat multi-segmental cervical myelopathy.Methods From April 2008 to March 2010,anterior cervical discotomy and fusion with self-locking cages were performed on 45 patients who suffered from multi-segmental cervical myelopathy,among of them there were 23 male and 22 female,aged from 32 to 67 years ( average 53 years).Recording the Japanese Orthopedic Association (JOA) scores and SF-36 scores in the protocol time point,in order to investigate the clinical outcome, meanwhile,accumulating the preoperation and postoperation X-ray films of cervical spine for measuring the height of intervertebral space,whole curvature of cervical spine and the rate of fusion by repeated measures analysis of variance.Results The mean follow-up time was 28.4 months(24-35 months).JOA scores ascended from preoperative 6.5 ±3.1 to postoperative 13.4 ± 1.7 ( F =17.84,P =0.001 ),the 7 scores of SF-36 improved significantly after operation (t=1.151-12.207,P ＜ 0.05),but mcntal health not.The fineness rate was 91.1％. Height of disc space ascended from preoperative (5.5 ± 1.8 ) mm to postoperative (8.3 ± 0.8 ) mm ( F =11.71,P =0.043),globle curvature of cervical spine ascended from preoperative 5° ± 7° to postoperative 10° ± 14°(F =234.53,P =0.000),the change of the two index was significantly,respectively.Fat necrosis in one case and hematoma in another case at the bone donor-site were found,both of the two cases were cured by physiotherapy.All of the 45 cases ( 111 segments) achieved bone fusion.Conclusion The use of anterior cervical discotomy and fusion with self-locking cages to treat multi-segmental cervical myelopathy posses many advantages as follows:satisfactory clinical outcome,minimally invasive,higher fusion rate,higher orthopaedic ability.