中国组织工程研究
中國組織工程研究
중국조직공정연구
Journal of Clinical Rehabilitative Tissue Engineering Research
2013年
35期
6345-6350
,共6页
梁伟之%高金伟%付磊%崔晓虎%贾俊峰
樑偉之%高金偉%付磊%崔曉虎%賈俊峰
량위지%고금위%부뢰%최효호%가준봉
骨关节植入物%骨与关节学术探讨%颈椎管狭窄症%侧块螺钉内固定%椎弓根内固定%全椎板减压%单开门减压%椎管扩大成形术%神经根麻痹
骨關節植入物%骨與關節學術探討%頸椎管狹窄癥%側塊螺釘內固定%椎弓根內固定%全椎闆減壓%單開門減壓%椎管擴大成形術%神經根痳痺
골관절식입물%골여관절학술탐토%경추관협착증%측괴라정내고정%추궁근내고정%전추판감압%단개문감압%추관확대성형술%신경근마비
bone and joint implants%academic discussion of bone and joint%cervical spinal stenosis%lateral mass screw internal fixation%laminectomy%single-door decompression%laminoplasty%nerve root palsy
背景：有部分学者认为颈椎管狭窄症减压植入内固定后神经根麻痹与颈椎稳定性以及颈椎生理曲度有关，目前还存在争议。<br> 目的：探讨颈椎管狭窄症后路全椎板减压侧块内固定与单开门减压椎管扩大成形治疗后C5神经根麻痹及稳定性。<br> 方法：选取29例颈椎管狭窄症患者进行后路减压植入物内固定治疗。方法①：颈椎管狭窄症后路全椎板减压侧块内固定，在C3-6侧块以及C7椎弓根钉内固定，关节突关节处造成粗糙面。方法②：根椐治疗前对正侧位平片及动力位片结合MRI、CT影像学图片，明确不稳定的节段，给予相应节段侧块内固定、椎板行单开门减压，椎管扩大成形治疗。<br> 结果与结论：29例颈椎管狭窄症患者随访8个月-2.3年，采用后路全椎板减压侧块内固定治疗的患者14例，植入后早期出现C5神经根麻痹2例，远期症状复发出现不全瘫3例，二次手术行瘢痕切除减压治疗；采用单开门减压椎管扩大成形治疗的患者15例，治疗后出现C5神经根麻痹肩外展功能不良1例，无治疗前症状复发病例。神经根麻痹最短6周，最长9个月均恢复。颈椎管狭窄症后路减压植入物内固定后，C5神经根麻痹与节段稳定性、颈椎生理曲度、椎管减压程度、脊髓漂移范围是否相关以及发生程度、远期因瘢痕致再度出现椎管狭窄，两种治疗方式的区别是否有意义，目前病例数有限，有待病例及临床经验的积累与观察。
揹景：有部分學者認為頸椎管狹窄癥減壓植入內固定後神經根痳痺與頸椎穩定性以及頸椎生理麯度有關，目前還存在爭議。<br> 目的：探討頸椎管狹窄癥後路全椎闆減壓側塊內固定與單開門減壓椎管擴大成形治療後C5神經根痳痺及穩定性。<br> 方法：選取29例頸椎管狹窄癥患者進行後路減壓植入物內固定治療。方法①：頸椎管狹窄癥後路全椎闆減壓側塊內固定，在C3-6側塊以及C7椎弓根釘內固定，關節突關節處造成粗糙麵。方法②：根椐治療前對正側位平片及動力位片結閤MRI、CT影像學圖片，明確不穩定的節段，給予相應節段側塊內固定、椎闆行單開門減壓，椎管擴大成形治療。<br> 結果與結論：29例頸椎管狹窄癥患者隨訪8箇月-2.3年，採用後路全椎闆減壓側塊內固定治療的患者14例，植入後早期齣現C5神經根痳痺2例，遠期癥狀複髮齣現不全癱3例，二次手術行瘢痕切除減壓治療；採用單開門減壓椎管擴大成形治療的患者15例，治療後齣現C5神經根痳痺肩外展功能不良1例，無治療前癥狀複髮病例。神經根痳痺最短6週，最長9箇月均恢複。頸椎管狹窄癥後路減壓植入物內固定後，C5神經根痳痺與節段穩定性、頸椎生理麯度、椎管減壓程度、脊髓漂移範圍是否相關以及髮生程度、遠期因瘢痕緻再度齣現椎管狹窄，兩種治療方式的區彆是否有意義，目前病例數有限，有待病例及臨床經驗的積纍與觀察。
배경：유부분학자인위경추관협착증감압식입내고정후신경근마비여경추은정성이급경추생리곡도유관，목전환존재쟁의。<br> 목적：탐토경추관협착증후로전추판감압측괴내고정여단개문감압추관확대성형치료후C5신경근마비급은정성。<br> 방법：선취29례경추관협착증환자진행후로감압식입물내고정치료。방법①：경추관협착증후로전추판감압측괴내고정，재C3-6측괴이급C7추궁근정내고정，관절돌관절처조성조조면。방법②：근거치료전대정측위평편급동력위편결합MRI、CT영상학도편，명학불은정적절단，급여상응절단측괴내고정、추판행단개문감압，추관확대성형치료。<br> 결과여결론：29례경추관협착증환자수방8개월-2.3년，채용후로전추판감압측괴내고정치료적환자14례，식입후조기출현C5신경근마비2례，원기증상복발출현불전탄3례，이차수술행반흔절제감압치료；채용단개문감압추관확대성형치료적환자15례，치료후출현C5신경근마비견외전공능불량1례，무치료전증상복발병례。신경근마비최단6주，최장9개월균회복。경추관협착증후로감압식입물내고정후，C5신경근마비여절단은정성、경추생리곡도、추관감압정도、척수표이범위시부상관이급발생정도、원기인반흔치재도출현추관협착，량충치료방식적구별시부유의의，목전병례수유한，유대병례급림상경험적적루여관찰。
BACKGROUND:Some scholars suggest that the nerve root palsy after cervical spinal stenosis treated with <br> decompression and implant internal fixation is related with the cervical stability and cervical lordosis, but there is controversial. <br> OBJECTIVE:To explore the C 5 nerve root palsy and stability after cervical spinal stenosis treated with posterior laminectomy lateral mass fixation and single-door decompression laminoplasty. <br> METHODS:Twenty-nine cervical spinal stenosis patients were selected and treated with posterior <br> decompression and implant internal fixation. Posterior laminectomy lateral mass fixation for the treatment of <br> cervical spinal stenosis:C3-6 lateral mass and C7 pedicel screw internal fixation was performed and caused rough surface on the facet joint;the unstable segment was confirmed according to the preoperative anteraposterior <br> plain film and dynamic radiographs combined with MRI and CT images, and then the corresponding segments were treated with lateral mass internal fixation, single-door decompression laminoplasty and laminoplasty. <br> RESULTS AND CONCLUSION:Al the 29 cervical spinal stenosis patients were fol owed-up for 8 months to 2.3 years. Among them, 14 cases were treated with posterior laminectomy lateral mass fixation, two cases had nerve root palsy in the early stage after implantation, three cases had incomplete paralysis after long-term symptom recurrence and treated with second surgery of scar remove and decompression;15 cases were treated with single-door decompression <br> laminoplasty, and one case had C 5 never root palsy and shoulder abduction dysfunctionafter treatment, no preoperative symptom recurrence. The nerve root palsy wil restored in 6 weeks for shortest and 9 months for longest. As the limitation of the case number, it is not clear whether there were significant differences in the correlation between C 5 nerve root <br> palsy and segmental stability, cervical lordosis, spinal decompression degree and the range for spinal cord shift, as wel as the nerve root palsy degree and the cervical spinal stenosis recurrence caused by forward scar between two <br> treatment methods, so accumulation observation of the cases and clinical experience are needed.
