| 颈椎减压钛网植骨术后的前路再手术治疗 |
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Received:September 09, 2013
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| 作者 | Author | 单位 | Unit | E-Mail |
| 陈斌辉 |
CHEN Bin-hui |
宁波市医疗中心李惠利医院骨二科, 浙江 宁波 315040 |
The Second Department of Orthopaedics, Li Hui Li Hospital of Ningbo Medical Center, Ningbo 315040, Zhejiang, China |
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| 顾仕荣 |
GU Shi-rong |
宁波市医疗中心李惠利医院骨二科, 浙江 宁波 315040 |
The Second Department of Orthopaedics, Li Hui Li Hospital of Ningbo Medical Center, Ningbo 315040, Zhejiang, China |
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| 张明 |
ZHANG Ming |
宁波市医疗中心李惠利医院骨二科, 浙江 宁波 315040 |
The Second Department of Orthopaedics, Li Hui Li Hospital of Ningbo Medical Center, Ningbo 315040, Zhejiang, China |
zmwxh@163.com |
| 桑裴铭 |
SANG Pei-ming |
宁波市医疗中心李惠利医院骨二科, 浙江 宁波 315040 |
The Second Department of Orthopaedics, Li Hui Li Hospital of Ningbo Medical Center, Ningbo 315040, Zhejiang, China |
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| 李杰 |
LI Jie |
宁波市医疗中心李惠利医院骨二科, 浙江 宁波 315040 |
The Second Department of Orthopaedics, Li Hui Li Hospital of Ningbo Medical Center, Ningbo 315040, Zhejiang, China |
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| 期刊信息：《中国骨伤》2014年27卷，第2期，第132-136页 |
| DOI：10.3969/j.issn.1003-0034.2014.02.010 |
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目的：分析颈椎减压钛网植骨术后疗效不佳的原因，探讨经前路再手术治疗该类患者的临床疗效.
方法：自2004年1月至2011年12月，采用经颈前路再次减压手术治疗颈椎钛网植骨术后患者16例，男7例，女9例，年龄46～75岁，平均61岁. 脊髓型颈椎病11例，神经根颈椎病2例，混合型颈椎病3例. 首次手术至再次手术时间4～12年，平均7年. 所有患者首次手术均行前路椎体次切钛网植骨内固定术，钛网植骨节段C3-C5 2例，C4-C6 8例，C4-C7 2例，C5-C7 4例，其中C4椎体次切钛网植入+C5，6椎间盘摘除cage植入1例. 患者术后症状好转或消失后再次复发13例；术后症状无明显改善2例；术后症状持续加重1例. 所有患者再手术前行颈椎正侧位片、CT、MRI检查，12例患者融合节段的邻近节段退变引起脊髓或神经根的压迫，其中上节段4例，下节段8例；3例患者因减压节段椎体后缘骨赘形成，造成脊髓或神经根受压；1例患者因前路减压不彻底脊髓仍受压. 应用日本骨科协会（JOA）评分系统，颈部功能障碍指数（ODI）及Odom分级标准来评价临床效果.
结果：全部患者通过前路完成二次手术减压，手术时间80～150 min，平均110 min；出血量30～200 ml，平均160 ml.1例患者出现30 ml较清引流液，怀疑脑脊液漏，术后第2天拔除引流液管后缝合引流口，10 d后拆线切口Ⅰ/甲级愈合. 其余患者无饮水呛咳、声音嘶哑、喉头水肿等并发症. 16例均获随访，时间12～28个月，平均16 个月. JOA评分及ODI指数术后2个月及末次随访与术前比较差异均有统计学意义（P<0.01），术后2个月与末次随访比较差异也有统计学意义（P<0.01）.末次随访JOA评分改善率为（72.9±0.2）%.按照Odom临床效果分级标准：优12例，良3例，可1例.
结论：颈椎减压钛网植骨术后，因手术减压不彻底、术后邻近节段的退变或新形成的各种致压因素、内植物引起的各种并发症等需要再次手术，而经前路再手术治疗患者能获得较好的临床疗效. |
| [关键词]:颈椎病 减压 手术后并发症 复发 再手术 |
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| Anterior revision surgery for the treatment of cervical spondylosis after anterior decompression and titanium mesh fusion |
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Abstract:
Objective: To analyze the reasons why anterior decompression and titanium mesh fusion for cervical spondylosis always show poor therapeutic effects,and to investigate the clinical effects of anterior revision surgery in these patients.
Methods: From January 2004 to December 2011,16 patients underwent anterior decompression and titanium mesh fusion for cervical myelopathy were treated with anterior revision surgery. There were 7 males and 9 females with an average age of 61 years old (ranged from 46 to 75 years),including 11 cases with cervical spondylotic myelopathy,2 cases with nerve root cervical spondylosis and 3 cases with mixed type cervical spondylosis. Average duration from the first operation to reoperation was 7 years(ranged from 4 to 12 years). In the first operation,titanium mesh segment located in C3-C5(2 cases),C4-C6(8 cases),C4-C7(2 cases),C5-C7(4 cases),and one of them,titanium mesh implantation in C4 and C5,6 intervertebral disk removal and cage fusion. After the first operation,symptom of 13 patients recurred after improvement or disappearance,2 patients did not show obvious improvement,and 1 patient aggravated. Cervical spine radiography,CT scan and MRI were performed in all patients before re-operation. There were 12 patients with compression of the spinal cord or nerve root caused by degenerative changes in adjacent segments of fusion segments,4 cases in upper segments,and 8 cases in lower segments;3 patients with compression of the spinal cord or nerve root caused by vertebral posterior osteophyte of decompressed segments;1 patient with compression of the spinal cord caused by incomplete anterior decompression. JOA,NDI and Odom classification were used to assess the clinical effects.
Results: All anterior revision surgery were successful with a mean time of 110 min (80 to 150 min) and mean bleeding of 160 ml(30 to 200 ml). There was 30 ml clear drainage fluid in 1 patient suspected of cerebrospinal fluid leakage. But the 2nd day after operation,the tube was removed and the drainage opening was sutured,and the suture incision healed in grade A after 10 days. Other patients had no complications such as dysdipsia,hoarseness,and laryngeal edema,etc. All patients were followed up for 12 to 28 months with an average of 16 months. Two months after operation and at last follow-up,JOA scores and ODI index had obviously improved than preoperation(P<0.01),and there was significant difference between postoperative 2 months and last follow-up (P<0.01). At the final follow-up,improvement rate of JOA was(72.9±0.2)%. According to the standard of Odom,12 cases got excellent results,3 good,1 fair.
Conclusion: After surgery of cervical decompression and bone graft fusion with titanium mesh,the patients need re-operation because of incomplete decompression,degenerative changes in adjacent segments or newly formed compression factors,and complications caused by implants. Anterior revision surgery can obtain good clinical effects. |
| KEYWORDS:Cervical spondylosis Decompression Postoperative complications Recurrence Reoperation |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 陈斌辉,顾仕荣,张明,桑裴铭,李杰.颈椎减压钛网植骨术后的前路再手术治疗[J].中国骨伤,2014,27(2):132~136 |
| 英文格式: | CHEN Bin-hui,GU Shi-rong,ZHANG Ming,SANG Pei-ming,LI Jie.Anterior revision surgery for the treatment of cervical spondylosis after anterior decompression and titanium mesh fusion[J].zhongguo gu shang / China J Orthop Trauma ,2014,27(2):132~136 |
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