中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2008年
6期
385-388
,共4页
肌萎缩侧索硬化%颈椎病%颈椎%外科手术%随访研究%预后
肌萎縮側索硬化%頸椎病%頸椎%外科手術%隨訪研究%預後
기위축측색경화%경추병%경추%외과수술%수방연구%예후
Amyotrophic lateral sclerosis%Cervical spondylosis%Cervical vertebrae%Surgical procedures,operative%Follow-up studies%Prognosis
目的 探讨颈椎手术对肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS)的病情进展和预后的影响.方法 收集确诊和拟诊的ALS患者329例,记录病史、流行病学,颈椎核磁检查结果及手术史等相关资料.部分患者每3个月进行随访,直至死亡或行气管切开术.结果 329例ALS患者中,有颈椎异常者156例(47.4%),其中行颈椎手术者19例(5.8%).手术组与未手术组诊断时发病年龄、性别构成、神经功能评分差异均无统计学意义,但从发病到确诊的时间,手术组[(23.0±6.5)个月]较未手术组[(13.7±7.9)个月]明显延长(t=4.800,P=0.000).通过随访,两组诊断后1年的病情进展速度和生存时间差异无统计学意义.结论 颈椎手术后患者确诊时间延长,病情继续进展,虽然未造成明显的病情进展加快和生存时间缩短,仍应尽量避免,对ALS和脊髓型颈椎病共病的患者施行手术应慎重.
目的 探討頸椎手術對肌萎縮側索硬化(amyotrophic lateral sclerosis,ALS)的病情進展和預後的影響.方法 收集確診和擬診的ALS患者329例,記錄病史、流行病學,頸椎覈磁檢查結果及手術史等相關資料.部分患者每3箇月進行隨訪,直至死亡或行氣管切開術.結果 329例ALS患者中,有頸椎異常者156例(47.4%),其中行頸椎手術者19例(5.8%).手術組與未手術組診斷時髮病年齡、性彆構成、神經功能評分差異均無統計學意義,但從髮病到確診的時間,手術組[(23.0±6.5)箇月]較未手術組[(13.7±7.9)箇月]明顯延長(t=4.800,P=0.000).通過隨訪,兩組診斷後1年的病情進展速度和生存時間差異無統計學意義.結論 頸椎手術後患者確診時間延長,病情繼續進展,雖然未造成明顯的病情進展加快和生存時間縮短,仍應儘量避免,對ALS和脊髓型頸椎病共病的患者施行手術應慎重.
목적 탐토경추수술대기위축측색경화(amyotrophic lateral sclerosis,ALS)적병정진전화예후적영향.방법 수집학진화의진적ALS환자329례,기록병사、류행병학,경추핵자검사결과급수술사등상관자료.부분환자매3개월진행수방,직지사망혹행기관절개술.결과 329례ALS환자중,유경추이상자156례(47.4%),기중행경추수술자19례(5.8%).수술조여미수술조진단시발병년령、성별구성、신경공능평분차이균무통계학의의,단종발병도학진적시간,수술조[(23.0±6.5)개월]교미수술조[(13.7±7.9)개월]명현연장(t=4.800,P=0.000).통과수방,량조진단후1년적병정진전속도화생존시간차이무통계학의의.결론 경추수술후환자학진시간연장,병정계속진전,수연미조성명현적병정진전가쾌화생존시간축단,잉응진량피면,대ALS화척수형경추병공병적환자시행수술응신중.
Objective To investigate the progression rate and prognosis of spinal decompression surgery after the onset of symptoms of amyotrophic lateral sclerosis(ALS).Methods A total of 329consecutive patients with deftnite or probable ALS were enrolled in the study.The patients were recorded with clinical features,history of spinal surgery,etc. Some of the patients were monitored every 3 months from visit to death or tracheostomy.Results Of 329 typical sporadic ALS,we found cervical spondylosis in 156(47.4%)patients,among whom 19(5.8%)underwent decompressive spinal surgery.No differences were noted regarding age at symptom onset,Sex and ALSFRS-R at time of diagnosis between ALS patients who underwent spinal surgery and other ALS patients.But the time from symptom onset to diagnosis was significantly longer in patients with spinal surgery((23.0±6.5)months vs(13.7±7.9)months,t=4.800,P=0.000).In the folow-up study,there were no differences in the rate of disease progression and survival between 2 groups.Conclusions All patients have inevitably progressed after spinal surgery.Although the surgery does not obviously fasten disease progression rate and shorten survival,it prolongs the time from disease onset to diagnosis,therefore should be handled with caution in patients with concurrent ALS and cervical spondylotic myelopathy.
