中国骨科临床与基础研究杂志
中國骨科臨床與基礎研究雜誌
중국골과림상여기출연구잡지
CHINESE JOURNAL OF CLINICAL AND BASIC ORTHO[AEDIC RESEARCH
2013年
3期
154-158
,共5页
徐灿华%吴增晖%张清顺%刘才俊
徐燦華%吳增暉%張清順%劉纔俊
서찬화%오증휘%장청순%류재준
颈椎病%脊髓%脊柱融合术%椎间融合器%骨移植
頸椎病%脊髓%脊柱融閤術%椎間融閤器%骨移植
경추병%척수%척주융합술%추간융합기%골이식
Cervical spondylosis%Spinal cord%Spinal fusion%Interbody fusion cage%Bone transplantation
目的:探讨自锁式颈椎前路椎间融合器治疗单椎间隙脊髓型颈椎病(CSM)的近期临床疗效。方法2010年3月至2011年12月广州军区广州总医院采用颈椎前路椎间盘髓核摘除、减压、自锁式椎间融合器植骨融合术治疗单间隙CSM患者39例,其中C3/410例、C4/517例、C5/612例。记录手术时间、术中失血量、住院时间及并发症发生情况;评估术前及术后3、6、12个月患者视觉模拟量表(VAS)评分和日本骨科学会(JOA)评分;同时测量手术前后融合节段Cobb角和椎间隙高度,判断椎间稳定性。结果手术时间(50±10)min,术中失血量(30±5)mL,住院时间(4.9±1.2)d,术后均未发现吞咽困难、伤口血肿、呼吸困难等并发症。39例患者获得随访,随访时间13~26个月(平均17.5个月)。术后3、6、12个月VAS评分、JOA评分、Cobb角及椎间高度均优于术前,差异有统计学意义(P<0.05)。按VAS评估标准,术后12个月随访时优27例、良10例、可2例,优良率95%(37/39);按JOA评分标准,术后12个月随访时优21例、良15例、可3例,优良率92%(36/39)。随访过程中未发现融合器移位、下沉、断裂,术后12个月颈椎过屈过伸位X线片判断椎间稳定率100%。结论自锁式颈椎前路椎间融合器具有良好的力学稳定性,可有效恢复颈椎生理曲度和椎间隙高度,治疗单间隙CSM具有手术创伤小、操作简单、并发症少、住院时间短等优点,椎管减压效果确切,临床症状获得有效改善。
目的:探討自鎖式頸椎前路椎間融閤器治療單椎間隙脊髓型頸椎病(CSM)的近期臨床療效。方法2010年3月至2011年12月廣州軍區廣州總醫院採用頸椎前路椎間盤髓覈摘除、減壓、自鎖式椎間融閤器植骨融閤術治療單間隙CSM患者39例,其中C3/410例、C4/517例、C5/612例。記錄手術時間、術中失血量、住院時間及併髮癥髮生情況;評估術前及術後3、6、12箇月患者視覺模擬量錶(VAS)評分和日本骨科學會(JOA)評分;同時測量手術前後融閤節段Cobb角和椎間隙高度,判斷椎間穩定性。結果手術時間(50±10)min,術中失血量(30±5)mL,住院時間(4.9±1.2)d,術後均未髮現吞嚥睏難、傷口血腫、呼吸睏難等併髮癥。39例患者穫得隨訪,隨訪時間13~26箇月(平均17.5箇月)。術後3、6、12箇月VAS評分、JOA評分、Cobb角及椎間高度均優于術前,差異有統計學意義(P<0.05)。按VAS評估標準,術後12箇月隨訪時優27例、良10例、可2例,優良率95%(37/39);按JOA評分標準,術後12箇月隨訪時優21例、良15例、可3例,優良率92%(36/39)。隨訪過程中未髮現融閤器移位、下沉、斷裂,術後12箇月頸椎過屈過伸位X線片判斷椎間穩定率100%。結論自鎖式頸椎前路椎間融閤器具有良好的力學穩定性,可有效恢複頸椎生理麯度和椎間隙高度,治療單間隙CSM具有手術創傷小、操作簡單、併髮癥少、住院時間短等優點,椎管減壓效果確切,臨床癥狀穫得有效改善。
목적:탐토자쇄식경추전로추간융합기치료단추간극척수형경추병(CSM)적근기림상료효。방법2010년3월지2011년12월엄주군구엄주총의원채용경추전로추간반수핵적제、감압、자쇄식추간융합기식골융합술치료단간극CSM환자39례,기중C3/410례、C4/517례、C5/612례。기록수술시간、술중실혈량、주원시간급병발증발생정황;평고술전급술후3、6、12개월환자시각모의량표(VAS)평분화일본골과학회(JOA)평분;동시측량수술전후융합절단Cobb각화추간극고도,판단추간은정성。결과수술시간(50±10)min,술중실혈량(30±5)mL,주원시간(4.9±1.2)d,술후균미발현탄인곤난、상구혈종、호흡곤난등병발증。39례환자획득수방,수방시간13~26개월(평균17.5개월)。술후3、6、12개월VAS평분、JOA평분、Cobb각급추간고도균우우술전,차이유통계학의의(P<0.05)。안VAS평고표준,술후12개월수방시우27례、량10례、가2례,우량솔95%(37/39);안JOA평분표준,술후12개월수방시우21례、량15례、가3례,우량솔92%(36/39)。수방과정중미발현융합기이위、하침、단렬,술후12개월경추과굴과신위X선편판단추간은정솔100%。결론자쇄식경추전로추간융합기구유량호적역학은정성,가유효회복경추생리곡도화추간극고도,치료단간극CSM구유수술창상소、조작간단、병발증소、주원시간단등우점,추관감압효과학절,림상증상획득유효개선。
Objective To explore short-term clinical efficacy of self-locking stand-alone anterior cervical interbody fusion (ACIF) cage for the treatment of single level cervical spondylotic myelopathy (CSM). Methods From March 2010 to December 2011, 39 patients with single level CSM (C3/4 in 10 cases, C4/5 in 17 cases and C5/6 in 12 cases) were performed anterior cervical discectomy, decompression, and autologous bone graft fusion with ACIF cage in Guangzhou General Hospital of Guangzhou Military Command. Operation time, intraoperative estimate blood loss, hospital stay and complications were recorded;At preoperation and 3, 6, 12 months after the surgery, visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) scores were evaluated, at the same time, Cobb angle as well as intervertebral height at fusion segments were measured. Results The operation time was (50 ± 10) min, intraoperative estimate blood loss was (30 ± 5) mL, and the duration of hospitalization was (4.9 ± 1.2) d. No postoperative dysphagia, wound hematoma, dyspnoea were found. All patients were followed up, with the average time of 17.5 months (13 to 26 months). Compared with VAS score, JOA score, Cobb angle and intervetebral height at preoperation, those at 3, 6, 12 months after the surgery had improved, the differences showed statistical significance (P <0.05). At 12 months’follow-up, there were excellent in 27 cases, good in 10 cases, fair in 2 cases, with the excellent and good rate of 95% (37/39) according to VAS evaluation standard;As for JOA score, there were excellent in 21 cases, good in 15 cases, fair in 3 cases, with the excellent and good rate of 92% (36/39). During the follow-up, no cage shift, sink or breakage had been observed. At 12 month after the surgery, cervical X-ray by flextion-extension position showed that intervertebral stabilization rate was almost 100%. Conclusions With good mechanical stability, self-locking ACIF cage could effectively restore cervical physiological lordosis and intervetebral height. For single level CSM patients, the treatment of ACIF has the advantages of less surgical injury, simple procedure, short hospital stay, which could obtain sufficient spinal canal decompression and improve clinical symptoms.