摘要
目的 分析12例颈椎病术后神经功能恶化患者的危险因素并探讨其预防措施.方法 回顾性分析2002年9月至2007年9月间手术治疗颈椎退变性疾病3703例,术后早期(1周内)突发神经症状恶化12例(占O.3%).统计患者年龄、病程、病变范围、JOA评分、术前合并症及术后脑脊液漏等一般资料;X线片测量椎管矢状径、Povlov比值、动态狭窄参数等指标;MRI矢状位中轴层测量受压最严重节段椎管侵占率.动态狭窄参数参照改良Rao等的方法,分别测量手术节段上位椎体后下缘与下位椎板前上缘之间(UV-LL)距离,以及下位椎体后上缘与上位椎板前下缘之间(LV-UL)距离.结果 12例术后神经功能恶化者中男9例,女3例.平均年龄51岁,平均病程71个月.术前JOA评分平均10分.症状恶化后JOA评分平均5分.随访2～5年,平均末次随访时间3年6个月.末次随访时JOA评分平均9分.术前手术节段椎管矢状径平均11.8 mm,Povlov比值平均O.65.术前UV-LL间距平均11.2mm,术后12.7mm;术前LV-UL平均15.1 mm,术后13.6mm.结论 术前合并高血压、糖尿病,颈椎椎管狭窄,颈椎动力性狭窄,病变节段3节段以上是颈椎病患者术后神经功能严重恶化的危险因素.致压物呈前上后下形压迫,而患者本身又存在UV-LL间距减小的动力性狭窄,前路手术应避免患者过度仰伸;致压物形态以前下后上形为主者,后路手术应尽量避免患者颈部过度屈曲.
Objective To discuss the risk factors of neurologic deterioration secondary to cervical spinal surgery . Methods 3703 patients with cervical degenerative disease treated surgically from September 2002 to September 2007 were reviewed. 12 patients suffered with neurologic deterioration within one week after operation. Age, course of disease, extent of disease, JOA score, preoperative companied disease and cerebrospinal leak were recorded. The saggital diameter of spinal canal, Povlov ratio and dynamic spinal stenosis parameter were measured on X-ray. And the dynamic spinal stenosis were measured using a modified Rao method in which both the distance from infer-posterior edge of upper vertebral body to the super-anterior edge of the lower laminar (UV-LL) and distance from super-posterior edge of lower vertebral body to the infer-anterior edge of the upper laminar (LV-UL) were measured. And the percentage of compression of spinal cord at the narrowest level was measured on middle saggital MRI section. Result There were 9 male and 3 female were included in these patients suffered from postoperative neurologic deterioration. The average age was 51 years and the average duration of symptoms was 71 months. The average JOA score declined from 10 preoperatively to 5 postoperatively and improved to 9 at the final follow up. The preoperative diameter of spinal canal was 11.8mm and the preoperative average Pavlov ratio was 0.65. The average distance of LV-UL was 11.2mm before operation and 12.7 after operation, while the distance of UV-LL was 15.1mm before operation and 13.6 after operation. Conclusion The risk factors of acute postoperative neurologic deterioration include Patients with preoperative hypertension, diabetes mellitus, cervical stenosis, cervical dynamic stenosis and more than 3 levels to acute postoperative neurologic deterioration.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2009年第12期1093-1098,共6页
Chinese Journal of Orthopaedics
基金
上海市科学技术委员会科研计划（课题编号:074119629）
关键词
颈椎
手术后并发症
脊髓压迫症
椎管狭窄
Cervical vertebrae
Postoperative complications
Spinal cord compression
Spinal stenosis
