治疗脊髓型颈椎病的两种手术方式对轴性症状的临床作用.pdfVIP

提 要 目的：探讨行后路全椎板减压侧块螺钉内固定术与单纯行颈后路单开门椎管扩大 成形术治疗脊髓型颈椎病，对患者术后轴性症状产生的影响及临床意义。 方法：本研究回顾性分析了近4 年（2007 年10 月～2011 年1 月）山东中医药大 学附属医院脊柱骨科，因脊髓型颈椎病分别行后路全椎板减压侧块螺钉内固定术与单 纯行颈后路单开门椎管扩大成形术治疗的患者，术后通过电话、信件、门诊等方式进 行随访，符合纳入标准且有完整资料者共40 例。其中A 组共19 例，行后路全椎板减 压侧块螺钉内固定术；B 组共21 例，颈后路单开门椎管扩大成形术。术后随访6～72 [1] 个月，参照日本矫形外科协会(JOA) 17 分评分法颈髓症判定标准对患者术前及术后 随访时的神经功能状态进行评估，同时，评估患者术后轴性症状和颈椎曲度指数。对 两组术式术后并发症（轴性症状）的发生率及相关因素进行对比研究。 结果：通过对行两种术式的患者术后神经功能状态、轴性症状和颈椎曲度指数的随访 观察研究，两组患者的神经功能恢复情况无明显差异。而行颈椎后路全椎板减压侧块 螺钉内固定术的患者轴性症状的发生率，颈椎生理曲度的丢失，较行单开门手术的患 者有较为明显的改善。 结论：在严格掌握手术适应症及科学、准确操作的基础上，行颈椎后路全椎板减 压侧块螺钉内固定术可以有效减少患者轴性症状的发生率，防止术后颈椎生理曲度的 丢失，对维持术后颈椎长期的稳定性起到积极作用。 关键词 脊髓型颈椎病 椎板减压 轴性症状 颈椎曲度指数 Clinical significance of two posterior operative ways on axial symptom for CSM Speciality: Orthopedics of TCM Author: Liu Yang Tutor: Prof. Hao Yanke Abstract Objective: To explore the clinic significance of two posterior operative ways on axial symptom for CSM. Method: Analyzing the cases of CSM during 4 years ( from October, 2007 to January, 2011 ) treated by two posterior operative ways in Spine Department, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, the author collected 40 patients with complete date and meeting the criteria after the surgery by means of telephone, mail and out-patient and then divided them into group A and group B. Group A includes 19 cases underwent laminectomy and lateral mass screw fixation, and group B includes 21 cases of received open-door laminoplasty. The follow-up period was 6-72 months, in which the author compared the improvement rate of the both groups and evaluated the two curative effect according to pre- and postoperat