| 颈椎管单开门扩大成形术后轴性痛并发症原因分析 |
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投稿时间：2017-08-25
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| 作者 | Author | 单位 | Address | E-Mail |
| 巩腾 |
GONG Teng |
中国人民武装警察部队后勤学院附属医院骨科中心脊柱科, 天津 300162
天津医院, 天津 300211
天津医科大学, 天津 300070 |
The Spinal Center Department of Orthopaedics, the Affiliated Hospital of Logistic College of Chinese People's Armed Police, Tianjin 300162, China |
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| 苏学涛 |
SU Xue-tao |
中国人民武装警察部队后勤学院附属医院骨科中心脊柱科, 天津 300162 |
The Spinal Center Department of Orthopaedics, the Affiliated Hospital of Logistic College of Chinese People's Armed Police, Tianjin 300162, China |
gongtengwujin@126.com |
| 夏群 |
XIA Qun |
中国人民武装警察部队后勤学院附属医院骨科中心脊柱科, 天津 300162 |
The Spinal Center Department of Orthopaedics, the Affiliated Hospital of Logistic College of Chinese People's Armed Police, Tianjin 300162, China |
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| 王景贵 |
WANG Jing-gui |
中国人民武装警察部队后勤学院附属医院骨科中心脊柱科, 天津 300162 |
The Spinal Center Department of Orthopaedics, the Affiliated Hospital of Logistic College of Chinese People's Armed Police, Tianjin 300162, China |
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| 期刊信息：《中国骨伤》2018年，第31卷，第1期，第23-29页 |
| DOI：10.3969/j.issn.1003-0034.2018.01.005 |
| 基金项目:中国人民武装警察部队后勤学院博士启动金（编号：WYB201109） |
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中文摘要:
目的：探讨多节段脊髓型颈椎病患者实施颈椎管单开门扩大成形联合Centerpiece微型板钉固定系统术后发生轴性痛（PAP）并发症的原因。
方法：对2010年1月至2013年12月采用单开门扩大成形辅助Centerpiece微型板钉固定治疗的79例脊髓型颈椎病患者进行回顾性分析，男45例，女34例；年龄48~75（58.7±4.4）岁；病程2.1~3.9（3.0±0.4）年；减压节段C3-C6者31例，C3-C7者9例，C4-C7者39例；其中42例合并颈椎后纵韧带骨化症。记录术后发生PAP并发症情况，比较PAP和非PAP两组患者术前颈椎曲度、颈椎前凸指数、合并颈椎不稳比例和屈伸活动度间差异，多元逻辑回归分析上述指标与PAP发生的关联性，通过术前、PAP首发时和术后6个月JOA评分，末次随访时JOA评分改善率和Odom标准评价手术疗效。
结果：79例患者获得随访，时间26~44（36±9）个月。术后12例发生PAP，均接受保守治疗。PAP组术前合并颈椎不稳比例高于非PAP组（P<0.05）。术前颈椎不稳系预测PAP发作的独立危险因素。两组间术前颈椎曲度、颈椎前凸指数和屈伸活动度差异均无统计学意义（P>0.05）。术后两组神经功能提高和疗效改善幅度差异均无统计学意义（P>0.05）。
结论：术前合并颈椎不稳，更易因单开门扩大成形术后各椎间活动度紊乱和应力再分配不均衡而继发PAP，正确处理术前颈椎不稳系预防颈椎管扩大成形术后PAP发生关键因素，PAP预后不会显著影响远期神经功能恢复。 |
| 【关键词】脊髓型颈椎病 术后轴性痛 椎管成形术 后纵韧带骨化症 |
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| Analysis of reason for postoperative axial pain caused by unilaterally open-door cervical laminoplasty |
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ABSTRACT
Objective:To explore the reason of postoperative axial pain (PAP) complication caused by unilaterally open-door cervical laminoplasty with Centerpiece mini-plate fixations for the treatment of multilevel cervical spondylotic myelopathy(CSM).
Methods:The clinical data of 79 patients with CSM who underwent unilaterally open-door cervical laminoplasty from January 2010 to December 2013 were retrospectively analyzed. There were 45 males and 34 females,aged from 48 to 75 years old with an average of (58.7±4.4) years,complicated with ossified posterior longitudinal ligament(OPLL) of 42 cases. Courses of disease were from 2.1 to 3.9 years with an average of (3.0±0.4) years. Decompression segment occurred in C3-C6 of 31 cases,C3-C7 of 9 cases,C4-C7 of 39 cases. The condition of PAP was record. Cervical curvature index,cervical lordosis angle,the rate of cervical instability,the motion of flexion and extension between PAP group and non-PAP group were compared preoperatively. Multivariate non-linear regression analysis was used to verify relationship between aforementioned parameters and incidence of PAP. JOA score of preoperative,postoperative 6 months and initial onset of PAP,the improvement rate of JOA score and Odom criteria at final follow-up were used to evaluate curative efficacy.
Results:All the patients were followed up from 26 to 44 months with an average of (36±9) months. Among them,12 patients occurred PAP who receive the conservative treatment. The rate of preoperative cervical instablility of PAP group were higher than that of non-PAP group(P<0.05). Preoperative cervical instability was the only independent risk factor in predicting occurrence of PAP. There were no significant differences in cervical curvature,cervical lordosis index,the motion of flexion and extension between PAP and non-PAP group before operation. There were no significant differences in the improvement of nerve function and clinical effect between PAP and non-PAP group after operation(P>0.05).
Conclusion:Preoperative cervical instability is prone to inducing the respectively intervertebral motion disorder and imbalance of stress redistribution,which results in PAP after cervical unilateral laminoplasty. Correct treatment of preoperative cervical instability is a key factor to prevent the occurrence of PAP after cervical laminoplasty,which would not affect long-term nerve functional recovery pronouncedly. |
| KEY WORDS Cervical spondylotic myelopathy Postoperative axial pain Laminoplasty Ossification of posterior longitudinal ligament |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 巩腾,苏学涛,夏群,王景贵.颈椎管单开门扩大成形术后轴性痛并发症原因分析[J].中国骨伤,2018,31(1):23~29 |
| 英文格式: | GONG Teng,SU Xue-tao,XIA Qun,WANG Jing-gui.Analysis of reason for postoperative axial pain caused by unilaterally open-door cervical laminoplasty[J].zhongguo gu shang / China J Orthop Trauma ,2018,31(1):23~29 |
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