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中国临床研究英文版:2020,33(6):818-821
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超声骨刀行后路单开门椎管成形术治疗多节段脊髓型颈椎病并部分颈椎不稳
(重庆医科大学附属永川医院脊柱外科,重庆 402160)
Single open door laminoplasty with ultrasonic scalpel in the treatment of cervical spondylotic myelopathy with partial cervical instability
(Department of Spinal Surgery, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China)
摘要
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Received:December 01, 2019   Published Online:June 20, 2020
中文摘要: 目的 评价在多节段脊髓型颈椎病(MCSM)并部分颈椎不稳患者用超声骨刀行后路单开门椎管成形术的效果观察。方法 2017年6月至2018年5月收治MCSM并部分颈椎失稳患者共32例,行超声骨刀行后路单开门椎管成形术。记录手术时间。随访症状、体征及神经功能恢复并记录。术前、术后及随访时JOA评分评估脊髓功能。X线片及CT复查评估颈椎曲度、稳定性、内固定位置及椎管扩大情况。对于颈椎后凸病例的颈椎曲度采用颈椎C2~C7夹角(CSA)评估恢复情况。结果 患者均如期完成手术。手术时间90~210(144.00±49.50)min。术后随访时间8~15(14.80±2.12)个月。术后X线片及CT检查显示合并颈椎后凸患者颈椎曲度恢复良好。所有患者无断钉、断棒及颈椎不稳定。CT检查显示螺钉位置良好,椎管扩大成形术疗效满意,术后随访无再关门及门轴断裂。JOA评分术前(6.47±1.41)分,术后1周(7.50±1.51)分,末次随访(10.75±1.54)分,术后1周和末次随访时JOA评分均高于术前,末次随访时JOA评分均高于术后1周,差异有统计学意义(P<0.01)。合并颈椎后凸的10例患者颈椎曲度评估,CSA术前(-10.70±1.54)°,术后1周(17.20±1.07)°,末次随访(17.60±1.25)°,术后1周和末次随访时CSA均优于术前,差异有统计学意义(P<0.01);术后1周和末次随访时比较无统计学差异(P>0.05)。结论 超声骨刀应用于后路单开门椎管成形术治疗MCSM是一种安全、有效的方法。有利于颈椎曲度的恢复,维持颈椎良好稳定性。
Abstract:Objecitve To evaluate the effect of open-door laminoplasty with ultrasonic scalpel in the treatment of multisegmental cervical spondylosis (MCSM) and cervical instability. Methods A total of 32 patients with MCSM and partial cervical instability were treated with single open door laminoplasty from June 2017 to May 2018.The operation time was recorded.The symptoms, signs and neurological function were recovered and recorded.JOA score was used to evaluate spinal cord function before, after and during follow-up.X-ray and CT Reexamination were used to evaluate cervical curvature, stability, internal fixation position and spinal canal enlargement.The recovery of cervical curvature in kyphosis was evaluated by the angle between C2 to C7(CSA). Results All patients completed the operation as scheduled. The operation time was 90-210 (144.00±49.50) min.The follow-up time was 8-15 (14.80±2.12) months.The postoperative X-ray and CT examination showed that the curvature of cervical spine recovered well in patients with kyphosis.All patients had no broken nail, broken rod or cervical instability.CT showed that the screw position was good and the effect of laminoplasty was satisfactory.JOA score was 6.47±1.41 before operation, 7.50±1.51 one week after operation, and 10.75±1.54 at the last follow-up.JOA score was higher at the first week and the last follow-up than before operation, and it was higher at the last follow-up than one week after operation (P<0.01).The evaluation of cervical curvature in 10 patients with kyphosis was -10.70°±1.54° before the operation, 17.20°±1.07° after the operation, and 17.60°±1.25° at the last follow-up.CSA was superior to that before the operation in 1 week and at the last follow-up (P<0.01).There was no significant difference between the first week and the last follow-up (P>0.05). Conclusion Ultrasound osteotomy is a safe and effective method in the treatment of MCSM.It is beneficial to the recovery of cervical curvature and the maintenance of good stability of cervical spine.
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