| 非创伤性硬膜外游离型颈椎间盘突出症的诊断和治疗 |
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Received:October 23, 2012
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| 作者 | Author | 单位 | Unit | E-Mail |
| 杨民 |
YANG Min |
皖南医学院附属弋矶山医院创伤骨科, 安徽 芜湖 241001 |
Department of Orthopaedics, Yijishan Hospital of Wan Nan Medical College, Wuhu 241001, Anhui, China |
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| 丁国正 |
DING Guo-zheng |
皖南医学院附属弋矶山医院创伤骨科, 安徽 芜湖 241001 |
Department of Orthopaedics, Yijishan Hospital of Wan Nan Medical College, Wuhu 241001, Anhui, China |
yjsyygk@sohu.com |
| 徐祝军 |
XU Zhu-jun |
皖南医学院附属弋矶山医院创伤骨科, 安徽 芜湖 241001 |
Department of Orthopaedics, Yijishan Hospital of Wan Nan Medical College, Wuhu 241001, Anhui, China |
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| 期刊信息：《中国骨伤》2013年26卷，第6期，第471-475页 |
| DOI：10.3969/j.issn.1003-0034.2013.06.008 |
| 基金项目:国家自然科学基金(编号:81171732);安徽省卫生厅医学科研课题(编号:2010C065) |
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目的: 探讨非创伤硬膜外游离型颈椎间盘突出症的临床特点和治疗方法。
方法: 自2002年1月至2011年7月采用颈前路椎体次全切除并后纵韧带切除髓核摘除减压内固定术治疗非创伤硬膜外游离型颈椎间盘突出症患者10例,其中男6例,女4例;年龄42～65岁,平均48.2岁;病程1个月～4年,平均15个月。所有患者术前有不同程度的四肢麻木、无力、行走不稳及括约肌功能障碍。术前颈椎MRI均提示有节段性颈脊髓受压。术前及术后随访时按JOA评分标准进行神经功能评分。
结果: 10例患者经术后15～32个月随访(平均21个月),无手术相关并发症发生。10例患者术前颈椎MRI 显示,穿破后纵韧带游离于椎体后方的髓核在T1相上和相应病变椎间隙等信号,而在T2相上为等或高信号。患者术后JOA评分由术前的7.20±1.55提高到13.60±1.90 (t=-11.8,P<0.001),其改善率为66.7﹪,优3例,良6例,可1例。
结论: 明确诊断后早期行前路椎体次全切除并后纵韧带切除髓核摘除减压内固定术是治疗非创伤硬膜外游离型颈椎间盘突出症成功的关键。 |
| [关键词]:硬膜外 颈椎 诊断 治疗 |
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| Diagnosis and management for the non-traumatic epidural sequestered cervical disc extrusion |
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Abstract:
Objective: To explore the clinical characteristics and management of non-traumatic epidural sequestered cervical disc extrusion.
Methods: From January 2002 to July 2011,the clinical data of 10 patients with non-traumatic epidural sequestered cervical disc extrusion were treated by anterior cervical mostly vertebraectomy and nucleus pulposus removal after decompression and internal fixation through longitudinal ligament resection. Of them,there were 6 males and 4 females with an average age of 48.2 years old (ranged from 42 to 65),the course of disease ranged from 1 month to 4 years (mean,15 months). All patients manifested numbness and weakness of four limbs,unstable walking and sphincter of oddi dysfunction. Preoperative MRI showed segmental cervical spinal cord compression. JOA scoring criteria was applied to evaluate preoperative and follow-up neurologic function.
Results: Ten patients were followed up,and the duration ranged from 15 to 32 months,with an average of 21 months. No complications related to opreation occurred. Preoperative MRI showed nucelus puplposus sequestered longitudinal ligament were on equal signal on T1-weighted and corresponding pathological,while it showed equal and high signal on T2-weighted. JOA score were increased from 7.20±1.55 preoperative to 13.60±1.90 postoperative (t=-11.8,P<0.001),and excellent in 3 cases,good in 6 cases and moderate in 1 case.
Conclusion: Anterior cervical mostly vertebraectomy and nucleus pulposus removal after decompression and internal fixation through longitudinal ligament resection after early diagnosis is the key to success of treating non-traumatic epidural sequestered cervical disc extrusion. |
| KEYWORDS:Epidural Cervical vertebrae Diagnosis Therapy |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 杨民,丁国正,徐祝军.非创伤性硬膜外游离型颈椎间盘突出症的诊断和治疗[J].中国骨伤,2013,26(6):471~475 |
| 英文格式: | YANG Min,DING Guo-zheng,XU Zhu-jun.Diagnosis and management for the non-traumatic epidural sequestered cervical disc extrusion[J].zhongguo gu shang / China J Orthop Trauma ,2013,26(6):471~475 |
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