CAJ | 학술논문

目的比较应用显微外科技术颈椎前路椎间盘切除减压、Cage植入、钛板内固定治疗脊髓型颈椎病(CSM)与传统颈椎前路手术,探讨显微镜外科手术的有效性和临床效果.方法回顾分析2008年1月至2010年6月之间,67例颈椎前路椎间盘切除减压、解剖型Cage同种异体骨植入、钛板内固定的临床资料,其中33例采用显微外科技术颈椎前路减压术,另34例采用标准开放手术.两种手术方式在手术时间、术中和术后出血量、术后下地时间及并发症等方面进行统计分析.并对所有病例进行术前和术后的神经学、影像学评估,比较减压效果.结果采用显微外科技术手术的33例,平均手术时间100 min,术中平均出血量60 ml,术后切口引流量40 ml,神经功能评分(JOA评分)术前8.43,术后3个月平均14.70,平均改善率83.2%.采用标准开放手术的34例,平均手术时间115 min,术中平均出血量100 ml,平均术后切口引流量50 ml,JOA评分术前7.54,术后11.84,平均改善率82.1%.两种手术方式在神经功能改善率上差异无统计学意义(P＞0.05),但在时间及出血量的比较,差异有统计学意义(P＜0.05).结论显微外科技术下颈椎前路椎间盘切除减压、解剖型Cage同种异体骨植入、钛板内固定治疗脊髓型颈椎病的方法相比于传统手术,术中显露充分,减压彻底,安全性高,出血量少,术后恢复快,效果良好.
목적 비교응용현미외과기술경추전로추간반절제감압、Cage식입、태판내고정치료척수형경추병(CSM)여전통경추전로수술,탐토현미경외과수술적유효성화림상효과.방법 회고분석2008년1월지2010년6월지간,67례경추전로추간반절제감압、해부형Cage동충이체골식입、태판내고정적림상자료,기중33례채용현미외과기술경추전로감압술,령34례채용표준개방수술.량충수술방식재수술시간、술중화술후출혈량、술후하지시간급병발증등방면진행통계분석.병대소유병례진행술전화술후적신경학、영상학평고,비교감압효과.결과 채용현미외과기술수술적33례,평균수술시간100 min,술중평균출혈량60 ml,술후절구인류량40 ml,신경공능평분(JOA평분)술전8.43,술후3개월평균14.70,평균개선솔83.2%.채용표준개방수술적34례,평균수술시간115 min,술중평균출혈량100 ml,평균술후절구인류량50 ml,JOA평분술전7.54,술후11.84,평균개선솔82.1%.량충수술방식재신경공능개선솔상차이무통계학의의(P＞0.05),단재시간급출혈량적비교,차이유통계학의의(P＜0.05).결론 현미외과기술하경추전로추간반절제감압、해부형Cage동충이체골식입、태판내고정치료척수형경추병적방법상비우전통수술,술중현로충분,감압철저,안전성고,출혈량소,술후회복쾌,효과량호.
Objective To comparison anterior cervical decompression and plating techniques for CSM between under microscope and traditional method retrospectively, investigate clinical result of surgery under microscope. Methods Sixty-seven patients with CSM underwent surgery of anterior cervical decompression and plating techniques were evaluated retrospectively from January 2008 to June 2010. Thirty-three patients underwent operation under microscope; thirty-four patients underwent traditional operation. The operating time, bleeding volume during operating and poster operating, walking time post-operation and complication were observed. Clinical outcomes were assessed by Japanese Orthopaedic Association (JOA), Image of before and after operation. Results Microsurgery operation time averaged of 100 minutes. Bleeding volume during the operation averaged of 60 ml, and after operation averaged of 40 ml. The JOA scores were improved from 8.43 pre-operatively to 14.70. Six months post operation, the average rage of JOA improvement were 83.2%. Traditional operation time averaged of 115 minutes. Bleeding volume during operation averaged of 100 ml, and after operation averaged of 50 ml. The JOA scores were improved from 7.45 pre-operatively to 11.84. Six months post operation, the average rage of JOA improvement were 82.1%. There were difference between two groups(P ＞ 0.05) in the JOA scores. No statistical difference (P ＜ 0.05) in bleeding volume and operating time. Conclusion The operation under microscope is restored significantly than the traditional method in bleeding volume, the surgical field, safety of operation, time of recovery and so on.