中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2014年
4期
613-618
,共6页
王鑫鑫%王利民%王卫东%刘屹林
王鑫鑫%王利民%王衛東%劉屹林
왕흠흠%왕이민%왕위동%류흘림
植入物%脊柱植入物%枕颈融合%椎间盘%椎体高度%枕颈角%下颈椎%退变%回顾性分析
植入物%脊柱植入物%枕頸融閤%椎間盤%椎體高度%枕頸角%下頸椎%退變%迴顧性分析
식입물%척주식입물%침경융합%추간반%추체고도%침경각%하경추%퇴변%회고성분석
cervical vertebrae%intervertebral disk%spinal fusion%follow-up studies%retrospective analysis
背景：枕颈融合是颅颈交界区畸形的主要治疗方法。对于非骨质疏松症患者，颈椎的退变主要表现在椎间盘，而椎体的高度基本保持恒定不变，所以可用颈椎间盘高度和与颈椎体高度和的比值(S值)衡量颈椎的退变，S值越小则颈椎退变越严重。<br> 目的：测量颅颈畸形枕颈融合内固定患者的颈椎侧位X射线片，分析融合过程中枕颈固定角度和融合后下颈椎退变的关系，确定最佳枕颈融合角度范围。<br> 方法：纳入因颅颈畸形行枕颈融合患者21例，根据融合后即刻枕颈角度(0c-C2角度)，将颅颈畸形枕颈融合患者分为3组，即枕颈角9°-22°组、枕颈角<9°组、枕颈角>22°组，其中融合后即刻0c-C2角度在9°-22°属于正常范围。测量融合前及融合后终末随访时各组S值及JOA评分，并进行统计学比较。<br> 结果与结论：融合前枕颈角9°-22°组、枕颈角<9°组、枕颈角>22°组JOA评分分别为(7.3±1.7)分、(7.2±1.6)分、(7.3±1.5)分，融合后随访分别为(14.2±1.5)分、(13.5±1.6)分、(13.3±1.5)分，3组 JOA 评分均有明显改善，枕颈角9°-22°组JOA改善程度明显较枕颈角<9°组、枕颈角>22°组好。融合前S值枕颈角9°-22°组、枕颈角<9°组、枕颈角>22°组分别为0.440±0.017，0.441±0.016，0.440±0.018，3组间差异无显著性意义。枕颈角9°-22°组融合后终末随访S值与融合前S值差异无显著性意义，枕颈角<9°组、枕颈角>22°组融合后终末随访S值均较其融合前S值明显减小。提示枕颈融合内固定时枕颈角应尽量在正常范围内，超过或小于正常范围均会加速下颈椎的退变进程。
揹景：枕頸融閤是顱頸交界區畸形的主要治療方法。對于非骨質疏鬆癥患者，頸椎的退變主要錶現在椎間盤，而椎體的高度基本保持恆定不變，所以可用頸椎間盤高度和與頸椎體高度和的比值(S值)衡量頸椎的退變，S值越小則頸椎退變越嚴重。<br> 目的：測量顱頸畸形枕頸融閤內固定患者的頸椎側位X射線片，分析融閤過程中枕頸固定角度和融閤後下頸椎退變的關繫，確定最佳枕頸融閤角度範圍。<br> 方法：納入因顱頸畸形行枕頸融閤患者21例，根據融閤後即刻枕頸角度(0c-C2角度)，將顱頸畸形枕頸融閤患者分為3組，即枕頸角9°-22°組、枕頸角<9°組、枕頸角>22°組，其中融閤後即刻0c-C2角度在9°-22°屬于正常範圍。測量融閤前及融閤後終末隨訪時各組S值及JOA評分，併進行統計學比較。<br> 結果與結論：融閤前枕頸角9°-22°組、枕頸角<9°組、枕頸角>22°組JOA評分分彆為(7.3±1.7)分、(7.2±1.6)分、(7.3±1.5)分，融閤後隨訪分彆為(14.2±1.5)分、(13.5±1.6)分、(13.3±1.5)分，3組 JOA 評分均有明顯改善，枕頸角9°-22°組JOA改善程度明顯較枕頸角<9°組、枕頸角>22°組好。融閤前S值枕頸角9°-22°組、枕頸角<9°組、枕頸角>22°組分彆為0.440±0.017，0.441±0.016，0.440±0.018，3組間差異無顯著性意義。枕頸角9°-22°組融閤後終末隨訪S值與融閤前S值差異無顯著性意義，枕頸角<9°組、枕頸角>22°組融閤後終末隨訪S值均較其融閤前S值明顯減小。提示枕頸融閤內固定時枕頸角應儘量在正常範圍內，超過或小于正常範圍均會加速下頸椎的退變進程。
배경：침경융합시로경교계구기형적주요치료방법。대우비골질소송증환자，경추적퇴변주요표현재추간반，이추체적고도기본보지항정불변，소이가용경추간반고도화여경추체고도화적비치(S치)형량경추적퇴변，S치월소칙경추퇴변월엄중。<br> 목적：측량로경기형침경융합내고정환자적경추측위X사선편，분석융합과정중침경고정각도화융합후하경추퇴변적관계，학정최가침경융합각도범위。<br> 방법：납입인로경기형행침경융합환자21례，근거융합후즉각침경각도(0c-C2각도)，장로경기형침경융합환자분위3조，즉침경각9°-22°조、침경각<9°조、침경각>22°조，기중융합후즉각0c-C2각도재9°-22°속우정상범위。측량융합전급융합후종말수방시각조S치급JOA평분，병진행통계학비교。<br> 결과여결론：융합전침경각9°-22°조、침경각<9°조、침경각>22°조JOA평분분별위(7.3±1.7)분、(7.2±1.6)분、(7.3±1.5)분，융합후수방분별위(14.2±1.5)분、(13.5±1.6)분、(13.3±1.5)분，3조 JOA 평분균유명현개선，침경각9°-22°조JOA개선정도명현교침경각<9°조、침경각>22°조호。융합전S치침경각9°-22°조、침경각<9°조、침경각>22°조분별위0.440±0.017，0.441±0.016，0.440±0.018，3조간차이무현저성의의。침경각9°-22°조융합후종말수방S치여융합전S치차이무현저성의의，침경각<9°조、침경각>22°조융합후종말수방S치균교기융합전S치명현감소。제시침경융합내고정시침경각응진량재정상범위내，초과혹소우정상범위균회가속하경추적퇴변진정。
BACKGROUND:Occipitocervical fusion is a major method for malformation of craniocervical junction. In patients without osteoporosis, the degeneration of cervical vertebra mainly presents in the intervertebral disk. The height of the vertebral body is constant basical y. Thus, the ratio (S value) of the height of cervical disc and the height of cervical vertebra can be used to measure the degeneration of cervical vertebra. The smal S value indicates severe degeneration of cervical vertebra. <br> OBJECTIVE:To measure the lateral radiograph of cervical vertebra in patients with craniocervical malformation undergoing occipitocervical fusion, to analyze the relationship between occipitocervical fixed angle during fusion and lower cervical spine degeneration after fusion, and to identify an optimal angle of occipitocervical fusion. <br> METHODS:A total of 21 patients with craniocervical malformation undergoing occipitocervical fusion were included. According to the occipitocervical angle (0c-C2 angle) immediately after fusion, the patients with craniocervical malformation undergoing occipitocervical fusion were assigned to three groups:occipitocervical angle 9°-22° group, occipitocervical angle<9° group, and occipitocervical angle>22° group. Immediate postoperative 0c-C2 angle in 9°-22° belonged to the normal angle range. S value and JOA score in each group were measured before and after fusion, during final fol ow-up. The statistics were compared. <br> RESULTS AND CONCLUSION:JOA scores in the occipitocervical angle 9°-22° group, occipitocervical angle<9° group, and occipitocervical angle>22° group, were respectively, (7.3±1.7) points, (7.2±1.6) points, and (7.3±1.5) points, before fusion, and (14.2±1.5) points, (13.5±1.6) points and (13.3±1.5) points after fusion. JOA scores were improved significantly in the three groups. JOA improvement was significantly better in the occipitocervical angle 9°-22° group than that in the occipitocervical angle<9° and>22° groups. Preoperative S values were respectively 0.440±0.017, 0.441±0.016, and 0.440±0.018 in the occipitocervical angle 9°-22° group, occipitocervical angle<9° group, and occipitocervical angle>22° group, and no significant difference was detected among the three groups. No significant difference in S value was detectable in the occipitocervical angle 9°-22° group between postoperative final fol ow-up and pre-operation. The S value was significantly smal er at postoperative final fol ow-up than pre-operation in the occipitocervical angle<9° and>22° groups. These results indicated that during occipitocervical fusion, occipitocervical angle should try to be normal, more than or less than normal range wil accelerate the degeneration of lower cervical spine.
