【作者】 李乔；

【导师】 白云深；

【作者基本信息】 吉林大学 ， 临床医学， 2010， 硕士

【摘要】 本研究对颈椎管狭窄症患者行颈椎后路单开门椎板扩大成形术(A组)及后路单开门椎板扩大成形联合侧块钉棒系统内固定术(B组)两种不同手术方式进行治疗,术后随访12～18个月,于手术前、后及最终随访时运用相同的临床疗效评分及影像学评价标准,结果显示:手术后两组患者的临床症状均有明显改善,两组患者的早期疗效无明显差别,但B组患者长期的颈椎稳定性明显高于A组,并且B组患者轴性症状的发生率也相对降低。然而,B组术式由于增加了手术步骤,所以平均手术时间、平均术中出血量、手术并发症及风险、手术费用等指标都超过了A组。本文就颈椎管狭窄症患者在行后路单开门椎板扩大成形术的同时是否应该联合侧块钉棒系统内固定术进行分析和讨论。结果表明,联合与不联合各有其优点和缺点,并且有各自的适应证。而联合侧块钉棒系统固定术可为患者提供长期可靠的颈椎稳定性,有效防止颈椎生理曲度异常和轴性症状的发生。在临床治疗中,应以患者的年龄、身体状况、临床症状与体征、影像学资料为依据,有针对性的选择有效的手术方式,最大限度的减轻患者的痛苦。更多还原

【Abstract】 Objective: It has been reported that cervical open-door laminoplasty can cause degree of cervical curve straightened or even kyphotic malformation to a certain extent. In addition, it can also leave long term axial symptoms. However, combining screw-rod fixation system can effectively stop cervical vertebae from instability along with prevent degree of cervical curve from straightening. In this study, the focus is to compare the clinical effectiveness of the two different therapy for treating degenerative cervical spinal stenosis.Methods:To review all 87 patients with degenerative cervical spinal stenosis who have had the operation. To separate those patients into two groups based on the type of operation i.e. Group A (non-fixation 40 patients) and Group B (fixation 47 patients). To analyze statistically using the identical clinical outcome & image measurement evaluation standard before and after the operation on the patient as well as following up.Results:RIS after surgery for Group A (non-fixation) is 53.2±19.81% and for Group B (fixation) is 61.16±15.08% , at the follow-up point JOA score for Group A is 12.41±4.21, and for Group B is 12.36±3.77(P=0.326>0.05). Incidence rate of axial symptoms for Group A is 37.5% and for Group B is 27.7% (P=0.015<0.05). Incidence rate of kyphotic malformation for Group A is 40% and for Group B is 12.8%(P=0.006<0.05). The reduced amount of ROM for Group A averaged at 6.8±10.5 and for Group B averaged at 8.2±11.3(P>0.05).Conclusion: The incidence rate of axial symptoms reduced as a result of combining open-door laminoplasty & lateral mass screw-rod fixation system in contrast with only open-door laminoplasty. Even to certain degree there was some loss on ROM of the patient after lateral mass screw-rod fixation, however, it gives a great sense of powerful support to the cervical vertebrae after the surgery which lowered the rate of cervical vertebrae instability from happening, hence benefiting the patient in the long run with regards to the living quality.更多还原