中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2010年
5期
337-341
,共5页
茅剑平%田伟%刘波%李勤%张贵林%胡临%李志宇%袁强%行勇刚%何达%肖斌
茅劍平%田偉%劉波%李勤%張貴林%鬍臨%李誌宇%袁彊%行勇剛%何達%肖斌
모검평%전위%류파%리근%장귀림%호림%리지우%원강%행용강%하체%초빈
颈椎病%椎管%并发症
頸椎病%椎管%併髮癥
경추병%추관%병발증
Cervical spondylosis%Spinal canal%Postoperation comphcations
目的 了解保留C2和C7棘突肌肉止点的改良颈椎后路椎管扩大成型术在对颈椎前凸角度的影响,轴性症状的发生率等方面的临床效果,探讨保留颈后部肌肉止点在防止颈椎后路椎管扩大成型术术后并发症方面的作用.方法回顾性分析2001年1月至2009年1月28例采用保留C2和C7棘突肌肉止点的改良颈椎后路椎管扩大成型术和21例传统的颈椎后路椎管扩大成型术在术后和术后3个月随访时JOA改善率,颈椎Cobb角和Ishihara指数的变化,轴性症状的情况,手术时间和出血量方面的结果,并对结果进行统计学分析.结果 改良颈椎后路椎管扩大成型术和传统术式在术后JOA改善率方面的作用相同,Slac术式术后3个月随访时在颈椎Cobb角和Ishihara指数的变化上要小于传统术式,改良颈椎后路椎管扩大成型术在术后随访时患者出现轴性症状的比例和新出现症状的比例要低于传统术式,改良颈椎后路椎管扩大成型术的手术时间要少于传统术式.结论 颈椎后路手术中尽量避免对肌肉的损伤可以减少术后并发症的发生率.改良颈椎后路椎管扩大成型术可以更好的保护颈后部的伸肌组群,可以获得与传统术式相同的神经减压效果,可以更好的维持颈椎前凸角度,术后轴性症状的发生率较低.
目的 瞭解保留C2和C7棘突肌肉止點的改良頸椎後路椎管擴大成型術在對頸椎前凸角度的影響,軸性癥狀的髮生率等方麵的臨床效果,探討保留頸後部肌肉止點在防止頸椎後路椎管擴大成型術術後併髮癥方麵的作用.方法迴顧性分析2001年1月至2009年1月28例採用保留C2和C7棘突肌肉止點的改良頸椎後路椎管擴大成型術和21例傳統的頸椎後路椎管擴大成型術在術後和術後3箇月隨訪時JOA改善率,頸椎Cobb角和Ishihara指數的變化,軸性癥狀的情況,手術時間和齣血量方麵的結果,併對結果進行統計學分析.結果 改良頸椎後路椎管擴大成型術和傳統術式在術後JOA改善率方麵的作用相同,Slac術式術後3箇月隨訪時在頸椎Cobb角和Ishihara指數的變化上要小于傳統術式,改良頸椎後路椎管擴大成型術在術後隨訪時患者齣現軸性癥狀的比例和新齣現癥狀的比例要低于傳統術式,改良頸椎後路椎管擴大成型術的手術時間要少于傳統術式.結論 頸椎後路手術中儘量避免對肌肉的損傷可以減少術後併髮癥的髮生率.改良頸椎後路椎管擴大成型術可以更好的保護頸後部的伸肌組群,可以穫得與傳統術式相同的神經減壓效果,可以更好的維持頸椎前凸角度,術後軸性癥狀的髮生率較低.
목적 료해보류C2화C7극돌기육지점적개량경추후로추관확대성형술재대경추전철각도적영향,축성증상적발생솔등방면적림상효과,탐토보류경후부기육지점재방지경추후로추관확대성형술술후병발증방면적작용.방법회고성분석2001년1월지2009년1월28례채용보류C2화C7극돌기육지점적개량경추후로추관확대성형술화21례전통적경추후로추관확대성형술재술후화술후3개월수방시JOA개선솔,경추Cobb각화Ishihara지수적변화,축성증상적정황,수술시간화출혈량방면적결과,병대결과진행통계학분석.결과 개량경추후로추관확대성형술화전통술식재술후JOA개선솔방면적작용상동,Slac술식술후3개월수방시재경추Cobb각화Ishihara지수적변화상요소우전통술식,개량경추후로추관확대성형술재술후수방시환자출현축성증상적비례화신출현증상적비례요저우전통술식,개량경추후로추관확대성형술적수술시간요소우전통술식.결론 경추후로수술중진량피면대기육적손상가이감소술후병발증적발생솔.개량경추후로추관확대성형술가이경호적보호경후부적신기조군,가이획득여전통술식상동적신경감압효과,가이경호적유지경추전철각도,술후축성증상적발생솔교저.
Objective To assess the effect of modified cervical expansive open-door laminoplasty preserving the posterior extensor musculature inserted into the C2 and C7 spinous process upon maintaining the cervical lordotic alignment and axial syndrome and to determine whether preserving the posterior extensor musculature inserted into C2 and C7 spinous process can reduce the complications. Methods Twenty-eight patients undergoing modified cervical expansive open-door laminoplasty preserving the posterior extensor musculature inserted into the C2 and C7 spinous process and 21 patients undergoing conventional C3-C7 cervical expansive open-door laminoplasty were investigated in pre-operative,post-operative and 3-month follow-up. The investigators assessed the effects of two different cervical laminoplasty types in the recovery rate of JOA score,the changes of Cobb angle and Ishihara's index,axial syndrome,operating duration and intra-operative blood loss,analyzed the results in SPSS and tried to find the difference in two operative types. Results There were the same results in the recovery rate of JOA score and intra-operative blood loss in modified expansive open-door cervical laminoplasty group and the conventional C3-C7 cervical expansive open-door laminoplasty group. The smaller changes of Cobb angle and Ishihara's index in the follow-up of modified laminoplasty group were found. The modified laminoplasty group had fewer patients suffering the axial syndrome in fallow-up.The operating duration was shorter in the modified laminoplasty group.Conclusion Preventing muscle injuries in cervical laminoplasty can reduce the incidence of complications.The modified expansive open-door cervical laminoplasty preserving the posterior extensor musculature inserted into C2 and C7 spinous process can protect cervical posterior extensor musculature. This is helpful to maintain the cervical lordotic alignment and reduce the incidence of post-operative axial syndrome.
