| 全椎板减压侧块螺钉固定与单开门椎管成形治疗无骨折脱位型颈髓损伤的病例对照研究 |
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投稿时间：2021-11-19
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| 作者 | Author | 单位 | Address | E-Mail |
| 李秋伟 |
LI Qiu-wei |
皖南医学院弋矶山医院骨科, 安徽 芜湖 241000 |
Department of Orthopaedics, Yijishan Hospital, Wannan Medical College, Wuhu 241000, Anhui, China |
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| 王林 |
WANG Lin |
皖南医学院弋矶山医院骨科, 安徽 芜湖 241000 |
Department of Orthopaedics, Yijishan Hospital, Wannan Medical College, Wuhu 241000, Anhui, China |
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| 王弘 |
and WANG Hong |
皖南医学院弋矶山医院骨科, 安徽 芜湖 241000 |
Department of Orthopaedics, Yijishan Hospital, Wannan Medical College, Wuhu 241000, Anhui, China |
807497519@qq.com |
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| 期刊信息：《中国骨伤》2022年，第35卷，第2期，第136-141页 |
| DOI：10.12200/j.issn.1003-0034.2022.02.009 |
| 基金项目: |
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中文摘要:
目的：比较全椎板减压侧块螺钉固定与单开门椎管成形治疗无骨折脱位型颈髓损伤的临床疗效。
方法：对2014年12月至2020年4月收治的75例无骨折脱位型颈髓损伤患者进行回顾性分析，其中男65例，女10例，年龄33~83（60.1±11.4）岁。按手术方式分为观察者（36例）与对照组（39例）。观察组采用C3-C6单开门椎管减压成形术治疗。对照组采用"揭盖"的方式掀开C3-C6全椎板，侧块螺钉植骨固定融合治疗。记录两组患者的一般情况（手术时间、术中出血量、住院时间）和并发症（轴性疼痛、脑脊液漏、术后C5神经麻痹）；采用疼痛视觉模拟评分（visual analogue scale，VAS），Nurick疼痛量表，日本骨科协会（Japanese Orthopaedic Associationscores，JOA）评分，美国脊髓损伤协会（American Spinal Injury Association，ASIA）损伤量表评估两组患者术后12个月临床症状的改善及相关功能恢复情况。
结果：两组患者在手术时间、术中出血量、住院时间方面差异无统计意义（P>0.05）；术后12个月所有患者的JOA评分、VAS、ASIA、Nurick评分与术前比较差异有统计学意义（P<0.05），组间比较差异无统计学意义；两组患者术后并发症在C5神经根麻痹、轴性疼痛发生率方面差异有统计学意义（P<0.05），在脑脊液漏并发症上两组差异无统计学意义（P>0.05）。
结论：颈椎后路手术全椎板减压侧块螺钉固定术与单开门椎管减压成形术治疗无骨折脱位型颈髓损伤，在恢复神经功能、缓解疼痛、改善日常行为能力等方面均能获得满意的疗效，但单开门椎管成形术具有创伤小、并发症发生率低的优势。 |
| 【关键词】无骨折脱位型颈髓损伤 脊髓损伤 减压 病例对照研究 |
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| A case-control study: the clinical efficacy of total laminectomy with lateral mass screw fixation and single open-door laminoplasty for cervical spinal cord injury without fracture and dislocation |
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ABSTRACT
Objective: To compare the clinical effects of total laminectomy with lateral mass screw fixation and single open-door laminoplasty in the treatment of cervical spinal cord injury without fracture and dislocation.
Methods: The clinical data of 75 patients with cervical spinal cord injury without fracture and dislocation treated from December 2014 to April 2020 were retrospectively analyzed,including 65 males and 10 females,aged from 33 to 83 years old with an average of (60.1±11.4) years. According to surgical method,the patients were divided into observation group (36 cases) and control group (39 cases). The observation group was treated with C3-C6 single open-door laminoplasty. In the control group,the C3-C6 whole lamina was opened by "uncovering",and the lateral mass screw was fixed and fused. The general conditions including operation time,intraoperative blood loss,hospital stay and complications such as axial pain,cerebrospinal fluid leakage,postoperative C5 nerve palsy were recorded. Visual analogue scale(VAS),Nurick pain scale,Japanese Orthopaedic Association(JOA) scores and American Spinal Injury Association(AISA) injury scale were used to evaluate the improvement of clinical symptoms and related functional recovery 12 months after operation.
Results: There were no statistically significant differences in operation time,intraoperative blood loss and hospital stay between two groups(P>0.05). There were statistically significant differences in JOA,VAS,ASIA and Nurick scores of the all patients between 12 months after surgery and before surgery (P<0.05),and there was no significant difference between groups. There was significant difference in the incidence of C5 nerve root palsy and axial pain between two groups(P<0.05),but there was no significant difference in the complications of cerebrospinal fluid leakage between two groups (P>0.05).
Conclusion: Total laminectomy with lateral mass screw fixation and single open-door laminoplasty in treating cervical spinal cord injury without fracture and dislocation can obtain satisfactory results in restoring nerve function,alleviating pain and improving daily behavior,but single open-door laminoplasty has the advantages of less trauma and low incidence of complications. |
| KEY WORDS Cervical spinal cord injury without fracture and dislocation Spinal cord injuries Decompression Case-control studies |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 李秋伟,王林,王弘.全椎板减压侧块螺钉固定与单开门椎管成形治疗无骨折脱位型颈髓损伤的病例对照研究[J].中国骨伤,2022,35(2):136~141 |
| 英文格式: | LI Qiu-wei,WANG Lin,and WANG Hong.A case-control study: the clinical efficacy of total laminectomy with lateral mass screw fixation and single open-door laminoplasty for cervical spinal cord injury without fracture and dislocation[J].zhongguo gu shang / China J Orthop Trauma ,2022,35(2):136~141 |
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