中华外科杂志
中華外科雜誌
중화외과잡지
CHINESE JOURNAL OF SURGERY
2012年
7期
601-606
,共6页
王辉%丁文元%申勇%张英泽%张为%杨大龙%孙亚澎%王林峰%曹来震%马雷
王輝%丁文元%申勇%張英澤%張為%楊大龍%孫亞澎%王林峰%曹來震%馬雷
왕휘%정문원%신용%장영택%장위%양대룡%손아팽%왕림봉%조래진%마뢰
颈椎%骨化,后纵韧带%椎板切除术%减压术,外科
頸椎%骨化,後縱韌帶%椎闆切除術%減壓術,外科
경추%골화,후종인대%추판절제술%감압술,외과
Cervical vertebrae%Ossification of the posterior longitudinal ligament%Laminectomy%Decompression,surgical
目的 探讨间接减压治疗颈椎后纵韧带骨化症术后轴性症状产生的原因及临床意义.方法 回顾性分析2005年2月至2010年2月接受手术治疗的颈椎后纵韧带骨化症76例患者资料,其中男性34例,女性42例；年龄37～74岁,平均52.1岁.病程11～56个月,平均32.1个月.患者分别行全椎板切除减压术(椎板切除组,19例)、单开门椎管扩大椎板成形术(扩大成形组,33例)、全椎板减压侧块螺钉内固定术(内固定组,24例).所有患者术前及术后均行颈椎X线片检查,术后对3组患者颈椎曲度指数(CCI)的丢失程度、日本骨科学会(JOA)评分的改善率、轴性症状的发生及严重程度进行评估.采用x2检验、SNK检验进行统计分析.结果 患者均获得随访,随访时间14～35个月,平均(21±5)个月,椎板切除组、扩大成形组及内固定组的CCI的丢失程度分别为4.2％±1.7％、2.9％±2.2％及2.3％±1.9％,差异有统计学意义(F=117.5,P＜0.01)；椎板切除组与扩大成形组、内固定组比较,差异均有统计学意义(q =2.94和4.23,P＜0.01).JOA评分改善率椎板切除组为58.3％、扩大成形组为64.3％、内固定组为66.7％,差异无统计学意义(P＞0.05).椎板切除组、扩大成形组及内固定组早期(术后3个月)轴性症状的发生率分别为7/19、30.3％及33.3％,差异无统计学意义(P＞0.05)；晚期轴性症状的发生率分别为5/19、12.1％及8.3％,3组比较差异有统计学意义(x2=13.762,P＜0.01)；椎板切除组与扩大成形组、内固定组比较,差异均有统计学意义(x2=6.368和11.481,P＜0.01).末次随访时椎板切除组患者未发生明显后凸畸形,扩大成形组患者无“关门”现象出现,内固定组患者无内固定物松动、断裂、脱出及相关神经血管并发症发生.结论使用颈椎间接减压3种术式治疗颈椎后纵韧带骨化症术后早期轴性症状的发生率无差别,全椎板切除减压术后晚期轴性症状的发生率高于其他2种术式,可能与颈椎曲度的丢失有关.
目的 探討間接減壓治療頸椎後縱韌帶骨化癥術後軸性癥狀產生的原因及臨床意義.方法 迴顧性分析2005年2月至2010年2月接受手術治療的頸椎後縱韌帶骨化癥76例患者資料,其中男性34例,女性42例；年齡37～74歲,平均52.1歲.病程11～56箇月,平均32.1箇月.患者分彆行全椎闆切除減壓術(椎闆切除組,19例)、單開門椎管擴大椎闆成形術(擴大成形組,33例)、全椎闆減壓側塊螺釘內固定術(內固定組,24例).所有患者術前及術後均行頸椎X線片檢查,術後對3組患者頸椎麯度指數(CCI)的丟失程度、日本骨科學會(JOA)評分的改善率、軸性癥狀的髮生及嚴重程度進行評估.採用x2檢驗、SNK檢驗進行統計分析.結果 患者均穫得隨訪,隨訪時間14～35箇月,平均(21±5)箇月,椎闆切除組、擴大成形組及內固定組的CCI的丟失程度分彆為4.2％±1.7％、2.9％±2.2％及2.3％±1.9％,差異有統計學意義(F=117.5,P＜0.01)；椎闆切除組與擴大成形組、內固定組比較,差異均有統計學意義(q =2.94和4.23,P＜0.01).JOA評分改善率椎闆切除組為58.3％、擴大成形組為64.3％、內固定組為66.7％,差異無統計學意義(P＞0.05).椎闆切除組、擴大成形組及內固定組早期(術後3箇月)軸性癥狀的髮生率分彆為7/19、30.3％及33.3％,差異無統計學意義(P＞0.05)；晚期軸性癥狀的髮生率分彆為5/19、12.1％及8.3％,3組比較差異有統計學意義(x2=13.762,P＜0.01)；椎闆切除組與擴大成形組、內固定組比較,差異均有統計學意義(x2=6.368和11.481,P＜0.01).末次隨訪時椎闆切除組患者未髮生明顯後凸畸形,擴大成形組患者無“關門”現象齣現,內固定組患者無內固定物鬆動、斷裂、脫齣及相關神經血管併髮癥髮生.結論使用頸椎間接減壓3種術式治療頸椎後縱韌帶骨化癥術後早期軸性癥狀的髮生率無差彆,全椎闆切除減壓術後晚期軸性癥狀的髮生率高于其他2種術式,可能與頸椎麯度的丟失有關.
목적 탐토간접감압치료경추후종인대골화증술후축성증상산생적원인급림상의의.방법 회고성분석2005년2월지2010년2월접수수술치료적경추후종인대골화증76례환자자료,기중남성34례,녀성42례；년령37～74세,평균52.1세.병정11～56개월,평균32.1개월.환자분별행전추판절제감압술(추판절제조,19례)、단개문추관확대추판성형술(확대성형조,33례)、전추판감압측괴라정내고정술(내고정조,24례).소유환자술전급술후균행경추X선편검사,술후대3조환자경추곡도지수(CCI)적주실정도、일본골과학회(JOA)평분적개선솔、축성증상적발생급엄중정도진행평고.채용x2검험、SNK검험진행통계분석.결과 환자균획득수방,수방시간14～35개월,평균(21±5)개월,추판절제조、확대성형조급내고정조적CCI적주실정도분별위4.2％±1.7％、2.9％±2.2％급2.3％±1.9％,차이유통계학의의(F=117.5,P＜0.01)；추판절제조여확대성형조、내고정조비교,차이균유통계학의의(q =2.94화4.23,P＜0.01).JOA평분개선솔추판절제조위58.3％、확대성형조위64.3％、내고정조위66.7％,차이무통계학의의(P＞0.05).추판절제조、확대성형조급내고정조조기(술후3개월)축성증상적발생솔분별위7/19、30.3％급33.3％,차이무통계학의의(P＞0.05)；만기축성증상적발생솔분별위5/19、12.1％급8.3％,3조비교차이유통계학의의(x2=13.762,P＜0.01)；추판절제조여확대성형조、내고정조비교,차이균유통계학의의(x2=6.368화11.481,P＜0.01).말차수방시추판절제조환자미발생명현후철기형,확대성형조환자무“관문”현상출현,내고정조환자무내고정물송동、단렬、탈출급상관신경혈관병발증발생.결론사용경추간접감압3충술식치료경추후종인대골화증술후조기축성증상적발생솔무차별,전추판절제감압술후만기축성증상적발생솔고우기타2충술식,가능여경추곡도적주실유관.
Objective To study the etiology and clinical significance of axial symptoms after posterior operative procedures for ossification of the posterior longitudinal ligament (OPLL).Methods From February 2005 to February 2010,76 patients with OPLL treated were retrospectively experienced.There were 34 male and 42 female with average of 52.1 years ( range from 37 to 74 years),the average duration of the disease was 32.1 months ( range from 11 to 56 months ).Nineteen patients underwent traditional laminectomy in group A,33 patients received open-door laminoplasty in group B and 24 patients underwent lateral mass screw fixation in group C.All patients underwent X-ray examination pre- and post operative,computed tomography were used for diagnosis of OPLL,the recovery rate was calculated using pre- and postoperative Japanese Orthopedic Association (JOA) scores for each patient.Pre- and postoperative cervical curvature index and axial symptoms were measured and compared.x2 test and SNK test were used as statistical methods.Results All patients were followed up for 14-35 months,average ( 21 ± 5 )months.Loss of cervical curvature index was 4.2％ ± 1.7％ in group A,2.9％ ±2.2％ in group B and 2.3％ ± 1.9％ in group C.The difference was significant in loss of cervical curvature indice between group A and B ( q =2.94,P ＜ 0.01 ),group A and C ( q =4.23,P ＜ 0.01 ).The average JOA recovery rate was 58.3％ for group A,64.3％ for group B and 66.7％ for group C.There was no significant difference in JOA recovery rate among the three groups( P ＞0.05 ).The rate of early evident axial symptoms was 7/19 in group A,30.3％ in group B and 33.3％ in group C and the difference was not statistically significant ( P ＞0.05).The incidence of late evident axial symptoms was 5/19 in group A,12.1％ in group B and 8.3％ in group C,the difference was not significant between group B and C (x2 =13.762,P ＜ 0.01 ),but of statistical difference between group A and B ( x2 =6.368,P ＜ 0.01 ),group A and C ( x2 =11.481,P ＜0.01 ).No kyphotic deformity in the group A,no "Close Door" phenomenon in group B and no internal failure in group C.Conclusion The incidence of early axial symptoms are of no significant difference among the three groups,but late axial symptoms are higher in the laminectomy than other groups,which may be associated with loss of cervical lordosis.
