| 颈椎病前路Hybrid手术保留颈后纵韧带的临床意义 |
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Received:April 14, 2014
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| 作者 | Author | 单位 | Unit | E-Mail |
| 贾育松 |
JIA Yu-song |
北京中医药大学东直门医院骨科, 北京 100700 |
Department of Orthopaedics, Dongzhimen Hosptial, Beijing University of Traditional Chinese Medicine, Beijing 100700, China |
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| 陈江 |
CHEN Jiang |
北京中医药大学东直门医院骨科, 北京 100700 |
Department of Orthopaedics, Dongzhimen Hosptial, Beijing University of Traditional Chinese Medicine, Beijing 100700, China |
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| 孙旗 |
SUN Qi |
北京中医药大学东直门医院骨科, 北京 100700 |
Department of Orthopaedics, Dongzhimen Hosptial, Beijing University of Traditional Chinese Medicine, Beijing 100700, China |
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| 李晋玉 |
LI Jin-yu |
北京中医药大学东直门医院骨科, 北京 100700 |
Department of Orthopaedics, Dongzhimen Hosptial, Beijing University of Traditional Chinese Medicine, Beijing 100700, China |
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| 郑晨颖 |
ZHENG Chen-ying |
北京中医药大学东直门医院骨科, 北京 100700 |
Department of Orthopaedics, Dongzhimen Hosptial, Beijing University of Traditional Chinese Medicine, Beijing 100700, China |
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| 白春晓 |
BAI Chun-xiao |
北京中医药大学东直门医院骨科, 北京 100700 |
Department of Orthopaedics, Dongzhimen Hosptial, Beijing University of Traditional Chinese Medicine, Beijing 100700, China |
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| 徐林 |
XU Lin |
北京中医药大学东直门医院骨科, 北京 100700 |
Department of Orthopaedics, Dongzhimen Hosptial, Beijing University of Traditional Chinese Medicine, Beijing 100700, China |
xulin_2011@sina.com |
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| 期刊信息：《中国骨伤》2015年28卷，第1期，第26-30页 |
| DOI：10.3969/j.issn.1003-0034.2015.01.007 |
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目的: 探讨颈椎前路Hybrid手术保留颈后纵韧带的临床效果及意义.
方法: 对2009年3月至2013年3月采用Hybrid术式治疗的颈椎病138例患者进行回顾性分析,男52例,女86例;年龄36～58岁,平均45.3岁;病程 3～16 个月.神经根型22例,脊髓型68例,混合型48例.所有患者Ⅰ期行Hybrid手术治疗,前路减压时均保留颈后纵韧带.通过JOA评分、影像学检查(手术前后置换节段活动度、颈椎整体活动度、脊髓矢状径)评价手术疗效.
结果: 所有手术顺利完成,手术时间60～125 min,平均90.6 min;术中出血量10～60 ml,平均30.1 ml.所有患者获得随访,时间12～48个月,平均 22.2个月.病变节段减压充分,术中保留的颈后纵韧带均无明显肥厚、增生及钙化等异常,假体位置及切口愈合良好,无不良并发症发生.术后神经根型颈椎病患者上肢根性症状全部缓解,脊髓型颈椎病患者术后肌力和感觉均有不同程度的恢复.JOA评分由术前的 (8.62±1.22)分增加至末次随访时的(14.26±1.47) 分(P<0.05).人工椎间盘稳定,置换节段和颈椎整体活动度分别为(14.2±5.6)°和(33.8±10.3)°,与术前比较差异均无统计学意义(P >0.05).脊髓矢状径由术前的(5.2±1.3) mm增加到术后的(8.8±0.5) mm(P<0.05).
结论: 对颈椎后纵韧带无明显病变的患者,颈椎前路Hybrid术中保留后纵韧带可获得充分的减压,手术临床疗效良好. |
| [关键词]:椎间盘 置换 脊柱融合术 后纵韧带 |
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| Clinical study of a cervical anterior Hybrid technique with posterior longitudinal ligament retained for cervical spondylosis |
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Abstract:
Objective: To explore the clinical effects and significances of a cervical anterior Hybrid technique with posterior longitudinal ligament retained in treating cervical spondylosis.
Methods: The clinical data of 138 patients with cervical spondylosis underwent cervical anterior Hybrid sugery were retrospectively analyzed from March 2009 to March 2013. There were 52 males and 86 females,the age ranged from 36 to 58 years old with an average of 45.3 years. Course of disease was from 3 to 16 months. Cervical spondylosis classification included 22 cases with nerve root type,68 cases with myelopathic type,48 cases with mixed type. All patients were treated with the primary Hybrid surgery and their cervical posterior longitudinal ligaments were retained in anterior decompression. JOA score and image examination were used to evaluate clinical effect,and image examination included range of motion of the replacement segment,range of motion of the whole cervical spine,the sagittal diameter of the spinal cord before and after operation.
Results: All operations were successful and operation time was 60 to 125 min (averaged 90.6 min),perioperative bleeding was 10 to 60 ml (averaged 30.1 ml). All patients were followed up from 12 to 48 months with an average of 22.2 months. All pathological segments obtained fully decompression,reserved posterior longitudinal ligament had no obvious hypertrophy,proliferation and calcification. The prosthesis had good location and the incision healed well without complications. Upper limbs root symptoms were completely relieved in the patients with cervical spondylotic radiculopathy,muscle strengths and sensations got different recovery in the patients with cervical spondylotic myelopathy. JOA score was increased from preoperative 8.62±1.22 to final follow up 14.26±1.47(P<0.05). Artificial intervertebral discs were stabilized in the patients,the replacement segment and range of motion of whole cervical spine were respectively(14.2±5.6)°and(33.8±10.3)°,there was no significant differences between preoperative and postoperative(P >0.05). Spinal cord sagittal diameter was increased from preoperative (5.2±1.3) mm to postoperative (8.8±0.5) mm (P<0.05).
Conclusion: Anterior cervical Hybrid surgery with posterior longitudinal ligament retained can achieve fully decompression and good clinical efficacy,we recommend retaining the normal posterior longitudinal ligament in surgery as complete as possible. |
| KEYWORDS:Intervertebral disk Replacement Spinal fusion 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: | 贾育松,陈江,孙旗,李晋玉,郑晨颖,白春晓,徐林.颈椎病前路Hybrid手术保留颈后纵韧带的临床意义[J].中国骨伤,2015,28(1):26~30 |
| 英文格式: | JIA Yu-song,CHEN Jiang,SUN Qi,LI Jin-yu,ZHENG Chen-ying,BAI Chun-xiao,XU Lin.Clinical study of a cervical anterior Hybrid technique with posterior longitudinal ligament retained for cervical spondylosis[J].zhongguo gu shang / China J Orthop Trauma ,2015,28(1):26~30 |
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