颈椎后路单开门椎管扩大术后引起轴性症状的原因及预防措施.docVIP

颈椎后路单开门椎管扩大术后引起轴性症状的原因及预防措施 　　[摘要]目的 探讨颈椎后路单开门椎管扩大术后引起轴性症状的原因及预防措施。方法 选取我院2009年10月～2013年10月采用颈椎后路单开门椎管扩大术治疗并获得完整随访的38例颈椎病患者作为研究对象，分为A、B两组。A组在术后早期进行颈肩背部肌肉等长舒缩运动及肌力锻炼，颈围领制动颈部4～8周，4～8周后循序渐进进行颈部关节活动度锻炼、扩胸运动锻炼。B组术后颈围领制动颈部12周，12周后行肌力及颈部关节活动度锻炼。随访采用门诊复查方式，根据患者颈部疼痛、僵硬、活动受限程度、术后MRI影像显示来评价轴性症状。根据患者术后症状轻重、对生活质量的影响、是否服用止痛药进行轴性症状分度。结果 术后A组轴性症状Ⅰ度28例（90.3%）、Ⅱ度3例（9.7%），B组轴性症状Ⅱ度1例（14.3%）、Ⅲ度5例（71.4%）、Ⅳ度1例（14.3%）。结论 颈椎后路单开门椎管扩大术后早期（术后3～5 d）进行颈肩背部肌肉等长舒缩运动及肌力锻炼，颈围领制动颈部4～8周，4～8周后循序渐进进行颈部关节活动度锻炼、扩胸运动锻炼可有效减少轴性症状的发生。 　　[关键词]关节囊悬吊法；单开门椎管扩大术；轴性症状；脊髓型颈椎病 　　[中图分类号] R681.5 [文献标识码] A [文章编号] 1674-4721（2016）08（a）-0021-04 　　[Abstract] Objective To explore the cause and preventive measure of axial symptoms caused after cervical posterior single open-door laminoplasty.Methods 38 cases of cervical spondylopathy treated with cervical posterior single open-door laminoplasty and achieved complete follow-up from October 2009 to October 2013 in our hospital were selected and divided into group A and group B.Group A was early given isometric relaxation and contraction motion，muscle strength exercise of neck，shoulder，back muscles after operation，the neck was brake for 4 to 8 weeks by neck collar，the neck joint activity degree exercise，breast enlargement exercise was carried out step by step after 4 to 8 weeks.Group B was given postoperative cervical collar neck brake for 12 weeks，muscle strength and neck joint activity degree exercise was carried out step by step after 12 weeks.The patients were followed up by outpatient review，axial symptoms was evaluated according to the patient′s neck pain，stiffness，limited degree of activity， postoperative MRI image display.Axial symptoms was graded according to the severity of the symptoms，the impact of the quality of life，whether the use of pain medication.Results After operation，grade Ⅰ of the axial symptoms in group A was 28 cases （90.3%） and grade Ⅱ was 3 cases （9.7%）.The axial symptoms in group B was 1 case （14.3%） of grade Ⅱ，5 cases （71.4%） of grade Ⅲ and 1