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李四波,叶晓健,顾小华.多节段脊髓型颈椎病术前颈椎曲度对椎管扩大椎板成形术术后神经功能恢复影响[J].脊柱外科杂志,2017,15(2):77-81.
多节段脊髓型颈椎病术前颈椎曲度对椎管扩大椎板成形术术后神经功能恢复影响     点此下载全文 (Fulltext)
李四波1  叶晓健1  顾小华2
1. 第二军医大学附属长征医院骨科, 上海 200003;
2. 上海中医药大学附属第七人民医院骨科, 上海 200137
基金项目:浦东新区卫生系统重点学科建设资助项目(PWZx2014-2017)
DOI:10.3969/j.issn.1672-2957.2017.02.003
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摘要:
      目的 探讨多节段脊髓型颈椎病患者术前颈椎曲度与椎管扩大椎板成形术术后神经功能之间的相关性。方法 选取2013 年1 月-2015 年12 月在第二军医大学附属长征医院实施椎管扩大椎板成形术的70 例多节段脊髓型颈椎病患者作为研究对象进行回顾性分析。按照患者术前X线片中的颈椎曲度将患者分为曲度正常组(A组)、曲度变直组(B 组)、轻度曲度后凸组(C 组),比较3 组患者术后各节段脊髓后移距离、神经功能恢复率,并探讨术前颈椎曲度、术后脊髓后移距离与神经功能恢复率之间的相关性。结果 3 组患者术后各节段脊髓后移距离组间差异无统计学意义(P> 0.05)。3 组患者术前、术后的组间日本骨科学会(JOA)评分、神经功能恢复率差异均无统计学意义(P>0.05);与术前相比,术后3 组患者的JOA评分均明显增高,差异具有统计学意义(P< 0.05)。颈椎曲度与神经功能恢复率、脊髓后移距离之间无相关性。结论 术前颈椎曲度变直及轻度后凸的多节段脊髓型颈椎病患者在实施椎管扩大椎板成形术后脊髓神经功能均可改善,曲度变直及轻度后凸可能不再是多节段脊髓型颈椎病行椎管扩大椎板成形术的禁忌证。
关键词:颈椎病  椎管狭窄  减压术,外科  椎扳切除术
Effect of preoperative cervical curvature on recovery of nerve function after expansive laminoplasty in multi-segmental cervical spondylotic myelopathy    Fulltext
LI Si-bo1  YE Xiao-jian1  GU Xiao-hua2
1. Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China;
2. Department of Orthopaedics, 7th People's Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200137, China
Fund Project:
Abstract:
      Objective To explore the correlation between preoperative cervical curvature and recovery of nerve function after expansive laminoplasty in multi-segmental cervical spondylotic myelopathy patients. Methods From January 2013 to December 2015, clinical data of the 70 multi-segmental cervical spondylotic myelopathy patients undergoing expansive laminoplasty in Changzheng Hospital were analyzed retrospectively. According to the cervical curvature on preoperative roentgenographs, the patients were divided into normal curvature group(group A), straight curvature group(group B), slight kyphosis group(group C). Postoperative posterior displacement of the spinal cord at each segment and recovery rate of nerve function were compared between the 3 groups. The correlation was explored between the preoperative cervical curvature, nerve function recovery rate and postoperative posterior displacement of the spinal cord. Results There was no significant difference in postoperative posterior displacement of spinal cord at each segment between the 3 groups(P> 0.05). Further, there were no significant difference between the 3 groups in preoperative Japanese Orthopaedic Association(JOA) score, post-operative JOA score and nerve function recovery rate(P> 0.05). In addition, there was a significant difference between postoperative and preoperative JOA score in each group(P< 0.05). There was no significant correlation between the preoperative cervical curvature, nerve function recovery rate and postoperative posterior displacement of spinal cord(P> 0.05). Conclusion Nerve function of multi-segmental cervical spondylotic myelopathy patients with preoperative straight cervical curvature and mild kyphosis can be improved after expansive laminoplasty. Straight curvature or mild kyphosis may no longer be a contraindication of expansive laminoplasty for multi-segmental cervical spondylotic myelopathy.
Keywords:Cervical spondylosis  Spinal stenosis  Decompression, surgical  Laminectomy
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