手术治疗脊髓型椎病的疗效观察.pdf

目 录 中文摘要-·····-············································I ABSTRACT·-··················-·····················-········．III 缩略词表·······-·································一···一一·Ⅵ 前言··-···································-···········-····1日U舌 ······································-················l 正文·······················-·············-·-···-······--····2 1、临床资料···················-··················-····-··2 2、方法·················-·············-·····-············2 3、结果····························-·····-············-··5 4、．i寸论····································-·············8 5、结语··················································13 参考文献······-············································14 附录一·········-·····································-一···16 综述·····················································16 参考文献-···································一···一一·一一·24 附录二········-························-··················-27 l咐表···”····-··一·一····一···-·-·一··一····一··-·一····一·33 致谢．．····一·”····一一···一”·一···一”·”··”一·””一一·35 中文摘要 目 的探讨脊髓型颈椎病手术治疗后中短期的疗效 方法脊髓型颈椎病手术方式多种多样，自有颈椎手术以来不断改进， 现颈椎手术常规有以下几种，分为颈前路椎体次全切除+融合、前路颈椎 间隙减压+融合、人工颈椎间盘置换术、颈后路单开门椎管扩大成形及椎 板切除减压融合术。选取2011年1月至2012年9月来自湖北省人民医院 收治的76例脊髓型颈椎病手术治疗患者，单节段27例，双节段12例， 三节段及以上36例，分别根据退变程度行不同的手术治疗方案，行颈前 路椎间盘摘除植骨融合内固定术23例，行椎体次全切除减压植骨融合内 固定术14例，行人工颈椎间盘置换术4例，行后路单开门减压cENTER PIEcE钢板固定术35例．并观察患者术后3月、6月及末次随访时脊髓功 能恢复情况，颈椎稳定情况，植骨融合率．测量颈椎曲度，及术后并发症。 结果 随访3月一12月，平均6．8个月。行颈前路单间隙椎间盘切除术， 平均耗时58min，平均出血45ml；行颈前路椎体次全切除术，平均耗时 出血200m1；行颈椎后路单开门减压CENTERPIEcE钢板固定术，平均耗 时2h，平均出血35oml；手术并发症发生死亡1人，颈部深部血肿1人， 睡眠型窒息1人，短暂性吞咽困难及声音嘶者5人，脑脊液漏者2人。JOA ±2．5 3)分，术后6月JOA评分平均(13．49±2．58)分，术后末次JOA 评分，采用两独立样本的t检验，po．05，有统计学差异；选取术后3 月JOA评分，以及术后6月JOA评分，采用两独立样本的t检验，p值 O．05，仍然有统计学差异；选取术后6月JOA评分，以及术后末次JOA 评分，采用两独立样本的t检验，p值O．05，有统计学差异。76例患者 中有75例患者神经功能都有不同程度恢复，均获得骨性愈合，术后融合 节段稳定，1例死亡，总体疗效良好。 结论脊髓型颈椎病患者，完善检查后选取适合的手术治疗，对缓解 病患症状体征，以及神经功能和颈椎稳定性的恢复，中短期疗