【作者】 高冀敏；

【导师】 马迅；

【作者基本信息】 山西医科大学 ， 骨科学， 2007， 硕士

【摘要】 目的:探讨脊髓型颈椎病术后疗效与手术时机、年龄、手术前病情、融合节段多少、手术前后路选择、颈椎融合节段椎间隙高度变化、颈椎弧度变化等相关因素的关系,建立术后疗效的多元性回归方程,为脊髓型颈椎病手术治疗及手术方式的选择提供有价值的参考。方法:用书信、电话、门诊预约等方式对山西医科大学第二临床医学院骨科2000年4月-2006年10月间613例脊髓型颈椎病手术病例进行随访,并复习病历资料。采集手术前后的JOA评分,并测量颈椎的弧度等数据。运用SPSS13.0进行统计学分析,来评价脊髓型颈椎病前路手术、后路手术的手术疗效,脊髓型颈椎病手术时机的疗效分析,脊髓型颈椎病单节段、多节段手术疗效,脊髓型颈椎病手术前后颈椎弧度改变对疗效的影响,为临床提供有力的指导。结果:脊髓型颈椎病的手术疗效与年龄、病程、术前JOA评分有关;与性别、手术内固定的方式、植骨方式无关;手术疗效前路明显优于后路;前路手术后D值、椎体融合节段高度、Cobb角、ROM角较术前明显改善,且改善程度与疗效呈正相关;后路术后的D值、ROM角的改变无统计学意义;影响脊髓型颈椎病前路手术疗效的因素依次为:病程、术前JOA评分、年龄;前路多元化回归方程(?)=64.915-o.642xl+2.140x2-0.143x3。影响脊髓型颈椎病后路手术疗效的因素依次为:术前JOA评分、年龄、病程。后路多元化回归方程(?)=65.469-0.298xl-0.400x2+1.882x3。结论:影响脊髓型颈椎病手术疗效的因素:1、年龄:年龄越大,疗效越差;2、病程:病程越长,疗效越差;3、术前JOA评分:术前JOA评分越低,疗效越差;4、手术入路:前、后路手术治疗脊髓型颈椎病均有显著疗效,前路疗效优于后路;5、内固定使用情况:使用内固定者效果优于非使用内固定者。与性别、植骨方式、内固定式方式无关。前路手术疗效的影响因素依次为:病程、术前JOA评分、年龄。与D值的改善及融合节段高度的改善正相关;后路手术疗效的影响因素依次为:术前JOA评分、年龄、病程。CSM一经确诊应早期手术,严格掌握手术适应证及手术方式。更多还原

【Abstract】 Objective:To study the relationship between the factors of the postoperative effect and the time of operation,age,situation before operation,the number of fusion segment,the method of anterior or posterior operation,the change of cervical fusion intervertebral height,postoperative cervical curve,etl,and establish a multiple linear regression equation to offer the valuable refer of the operative treatment for cervical spondylotic myelopathy.Method:613 patients with cervical spondylotic myelopathy were followered up in the affiliated hospital of shanxi medical University from April 2004 to October 2006 by the way of letters,telephone and outpatient bespeak,and review the date of case history.JOA score were collected before and after operation,and the curve of cervical were measured.Statistical regressive analysis was conducted to evaluate the operation curative effect of anterior and posterior method,the curative effect analysis of operation time,the operative effect of single and multiple segment,the curative effect of cervical curve of before and postoperation,and to offer the guidance for clinical prectise.Result:The curative operation effect of cervical spondylotic myelopathy is related to age,disease course,and JOA score before operation.There is no statistical significance between the curative effect and patients gender,the method of inter fix operation and the method of bone embedded.D value of the anterior method,the hight of the cervical fusion segment,Cobb angle and ROM angle are obviously improved,and the degree of the improved is positive correlated with the curative effect.There is no statistical significance as to D value of posterior method and ROM angle.Factors that affect the anterior operative effect of cervical spondylotic myelopathy are disease course,JOA score before operation and age.The multiple linear regression equation of the anterior method is y=64.915-0.642xl+2.140x2-0.143x3.Factors that affect the posterior operative effect of cervical spondylotic myelopathy are JOA score before operation,age and disease course.The multiple linear regression equation of the posterior method is y=65.469-0.298xl-0.400x2+1.882x3.Conclusion:Factors that affect the operative effect of cervical spondylotic myelopathy are: 1.Age:the older of the patient,the poorer of the curative effect.2.Disease course:the longer of the disease course,the more miserable of the curative effect.3.JOA score before operation:the lower of the JOA score,the poorer of the curative effect.4.Method of operation:Both anterior and posterior operation method have obviously curative effect,but the anterior method is superior to posterior method.5.The situation of interior fix:the effect of interior fixation is superior to the effect without interior fixation.The curative effect is not related to gander,method of bone embedded and method of interior fixation.Factors that affect the anterior operative effect of cervical spondylotic myelopathy are disease course,JOA score before operation and age.The curative effect is positive correlated to the changement of D value and the hight of the fusion segment.Factors that affect the posterior operative effect of cervical spondylotic myelopathy are JOA score before operation,age and disease course.Earlier operation should be performed as soon as CSM is diagnosed,and the candidate of operation and method of operation should be strictly assessed.更多还原