摘要
目的通过脊髓型颈椎病采用不同术式治疗后脊髓功能改善及患者预后状况的观察，探讨术后并发症及“弓弦效应”产生机制。方法回顾性分析2001年1月至2002年10月收治的经前路减压并获随访的56例和后路减压后获得随访的62例患者，随访时间均在24个月以上，于术前、术后3个月（早期）及24个月以上（中期）行脊髓功能JOA评分、体感诱发电位和颈椎主动活动度检查，对比两组减压术后早、中期疗效。结果获得随访的118例患者，前路手术56例中优14例（25％），良29例（51．79％），可10例（17．86％），差3例（5．36％）；后路手术62例中优23例（37．10％），良31例（50％），可7例（11．29％），差1例（1．61％）。前、后路减压术后不同时间JOA评分改善率与SEP波幅、潜伏期变动率差异有统计学意义；两种减压术后颈椎各向主动活动度差异有统计学意义。发生术后并发症的前路组7例和后路组13例，经保守治疗后逐渐缓解。结论（1）仅以“C5神经根麻痹”概念解释上述术后不适症状较牵强，应系术中脊髓内组织受损所致；（2）后路椎板减压因直接扩大椎管容积及产生“弓弦效应”，较前路手术同期脊髓功能恢复效果更显著；（3）后路术后颈椎主动活动度较一般人群有轻微减小，前路组主动活动度又较后路组有一定程度地下降。
Objective To analyze functional improvement of spinal cord and the prognosis of two surgical approaches for the stenosis of cervical spinal canal;to investigate the mechanisms concerning post- operative complications and ‘bow-string potency＇. Methods 118 cases from 114 cases who underwent anterior decompression, fusion with ilium graft and internal fixation and 158 cases who underwent dorsal laminectomy from January 2001 to October 2002 were follow-up for at least 24 months and examined with the evaluation systems of Japanese Orthopaedic Association Score, somatosensary evoked essential and initiative range of motion to compare preoperative, short-term and long-term efficacy. Results According to selected standard of improvement rate, therapeutic effect of 56 sufferers among ventral approach group was analyzed, 14 cases（25% ） excellent, 29 cases（51.79% ）good, 10 eases（17.86%） fair, 3 cases（5.36%） poor; postoperative effect of 62 sufferers from dorsal approach group was analyzed, 23 cases（37.10%） excellent, 31 cases（50%） good, 7 cases（11.29%） fair, 1 case（1.61%） poor. Concerning JOA evaluation of spinal cord function, initiative range of motion and correlated parameters of SEP, there was significant difference between two decompression approach in postoperative periods. 7 cases from anterior approach and 13 patients from posterior approach disturbed by postoperative complications were gradually rehabilitated through conservative treatment. Conclusion 1 ）We should not generalize most discomfort after surgery with the sequela of ‘palsy of Cervical 5 spinal root＇, the essence of above-mentioned symptoms may be cervical cord impairment due to decompression process ,which would be alleviated by appropriate intervention;2）The efficiency of posterior decompression get the better of anterior decompression in light of fundamentally enlarging available space within vertebral canal and the generation of ‘bow-string potency＇;3）Initiative range of motion after posterior approach became a little smaller than normal individuals, however, the corresponding parameters after anterior approach lower than the former two groups.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2008年第9期714-719,共6页
Chinese Journal of Orthopaedics
基金
天津市科委自然科学基金资助项目（043609011）
关键词
颈椎
脊髓压迫症
病例对照研究
Cervical vertebrae
Spinal cord compression
Case-control studies
