临床医学
臨床醫學
림상의학
CLINICAL MEDICINE
2015年
6期
4-6
,共3页
福嘉欣%夏英鹏%江汉%江毅%肖联平%田永刚
福嘉訢%夏英鵬%江漢%江毅%肖聯平%田永剛
복가흔%하영붕%강한%강의%초련평%전영강
分期%前后路联合%多节段%脊髓型颈椎病
分期%前後路聯閤%多節段%脊髓型頸椎病
분기%전후로연합%다절단%척수형경추병
Staging%Combined anterior and posterior%Multi segmental%Cervical spondylotic myelopathy
目的:探讨分期前后联合手术治疗多节段脊髓型颈椎病的治疗效果。方法本研究分期进行颈椎前后路手术,即首先行后路椎板减压或单开门椎管扩大成形,后行前路短节段经椎间隙或椎体次全切除减压联合治疗多节段脊髓型颈椎病患者28例,手术前后根据日本骨科协会评估分数(JOA)进行评分,随访12~120个月。通过 JOA 评分的改善情况,Odom’s 分级随访结果及颈椎活动度的变化三方面对比单纯前路或单纯后路多节段脊髓型颈椎病的治疗效果。结果采用前后路联合组第1次术后 JOA 评分为(12.40±0.65)分,第二次术后 JOA 评分为(14.05±0.19)分,改善率为76.31%,差异有统计学意义(t =0.014,P ﹤0.05)。分别对比三种不同方式术后 Odom’s 分级进行评价,前后路联合组优良率为80.9%,三组对比差异有统计学意义(u =0.024,Z ﹤0.05)。结论分期前后路联合治疗多节段脊髓型颈椎病可充分改善患者的神经功能恢复,可得到比单纯前路及后路手术更好的减压效果,并避免了单纯后路减压破坏整体脊柱的稳定性和单纯前路减压整体颈椎活动度的丢失,降低了手术风险,减少术后并发症的发生。
目的:探討分期前後聯閤手術治療多節段脊髓型頸椎病的治療效果。方法本研究分期進行頸椎前後路手術,即首先行後路椎闆減壓或單開門椎管擴大成形,後行前路短節段經椎間隙或椎體次全切除減壓聯閤治療多節段脊髓型頸椎病患者28例,手術前後根據日本骨科協會評估分數(JOA)進行評分,隨訪12~120箇月。通過 JOA 評分的改善情況,Odom’s 分級隨訪結果及頸椎活動度的變化三方麵對比單純前路或單純後路多節段脊髓型頸椎病的治療效果。結果採用前後路聯閤組第1次術後 JOA 評分為(12.40±0.65)分,第二次術後 JOA 評分為(14.05±0.19)分,改善率為76.31%,差異有統計學意義(t =0.014,P ﹤0.05)。分彆對比三種不同方式術後 Odom’s 分級進行評價,前後路聯閤組優良率為80.9%,三組對比差異有統計學意義(u =0.024,Z ﹤0.05)。結論分期前後路聯閤治療多節段脊髓型頸椎病可充分改善患者的神經功能恢複,可得到比單純前路及後路手術更好的減壓效果,併避免瞭單純後路減壓破壞整體脊柱的穩定性和單純前路減壓整體頸椎活動度的丟失,降低瞭手術風險,減少術後併髮癥的髮生。
목적:탐토분기전후연합수술치료다절단척수형경추병적치료효과。방법본연구분기진행경추전후로수술,즉수선행후로추판감압혹단개문추관확대성형,후행전로단절단경추간극혹추체차전절제감압연합치료다절단척수형경추병환자28례,수술전후근거일본골과협회평고분수(JOA)진행평분,수방12~120개월。통과 JOA 평분적개선정황,Odom’s 분급수방결과급경추활동도적변화삼방면대비단순전로혹단순후로다절단척수형경추병적치료효과。결과채용전후로연합조제1차술후 JOA 평분위(12.40±0.65)분,제이차술후 JOA 평분위(14.05±0.19)분,개선솔위76.31%,차이유통계학의의(t =0.014,P ﹤0.05)。분별대비삼충불동방식술후 Odom’s 분급진행평개,전후로연합조우량솔위80.9%,삼조대비차이유통계학의의(u =0.024,Z ﹤0.05)。결론분기전후로연합치료다절단척수형경추병가충분개선환자적신경공능회복,가득도비단순전로급후로수술경호적감압효과,병피면료단순후로감압파배정체척주적은정성화단순전로감압정체경추활동도적주실,강저료수술풍험,감소술후병발증적발생。
Objective To investigate the effects of stage combined anterior and posterior operation on multi segmental cervical spondylotic myelopathy. Methods Twenty-eight multi segmental cervical spondylotic myelopathy patients were treated by the stages combined anterior and posterior operationat,and were given the posterior decompression or single door laminoplasty,then received the short segment after anterior vertebra clearance or corpectomy decompression. The scores were assessed according to the Japanese Orthopaedic Association(JOA)assessment scores before and after operation,and all the cases were followed-up for 12 - 120 months. Compared the effects of simple anterior and simple posterior operation from three aspects:improvement of JOA score,the followed-up results of Odom’s and the change of cervical activity. Results The JOA score of the first postoperative in combined anterior and posterior group was 12. 40 ± 0. 65,and 14. 05 ± 0. 19 of the second operation,the improvement rate was 76. 31% ,the difference was statistically significant(t = 0. 014,P ﹤ 0. 05). Three different ways were compared postoperatively. The Odom’s grade was evaluated of the three different operation methods,combined anterior and posterior group,the excellent and good rate of combined group was 80. 9% . The differences were statistically significant. Conclusion The stage combined an-terior and posterior operation in the treatment of multi segmental cervical spondylotic myelopathy can fully improve the recovery of neurological function,get better decompression effect than simple anterior and posterior operation,and avoid damaging the whole spinal stability of simple posterior decompression and the loss of activity of cervical vertebra of simple anterior decompression,re-duce the operation risk and the occurrence of postoperative complications.