| 龙再现,代叶红,徐广辉,李振环,刘晓东,洪晓亮,贾连顺.前路椎体次全切除术与后路全椎板切除术治疗颈椎脊髓损伤的疗效对比[J].脊柱外科杂志,2017,15(4):217-222. |
前路椎体次全切除术与后路全椎板切除术治疗颈椎脊髓损伤的疗效对比  点此下载全文 (Fulltext) |
| 龙再现1 代叶红1 徐广辉2 李振环2 刘晓东2 洪晓亮2 贾连顺3 |
1. 重庆医科大学附属第二医院秀山分院骨科, 重庆 409900;
2. 第二军医大学附属长征医院闸北分院骨科, 上海 200070;
3. 第二军医大学附属长征医院骨科, 上海 200003 |
| 基金项目：上海市科委西医引导资助项目（15411970400） |
| DOI：10.3969/j.issn.1672-2957.2017.04.005 |
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| 摘要： |
| 目的 对比分析前路椎体次全切除术与后路全椎板切除术治疗颈椎脊髓损伤的疗效。方法 回顾性分析2015年1月-2016年1月，重庆医科大学附属第二医院秀山分院骨科和第二军医大学附属长征医院闸北分院骨科收治的76例重度颈椎脊髓损伤患者临床资料。术前所有患者均出现完全性或不完全性瘫痪症状，美国脊髓损伤协会（ASIA）分级A级（完全性瘫痪，48例）或B级（不完全性瘫痪，28例），其中34例行前路椎体次全切除减压内固定术（前路组），42例行后路全椎板切除减压内固定术（后路组）。记录所有患者呼吸机使用时间，气管插管时间，术前、术后ASIA运动及感觉评分，术后并发症发生情况。结果 所有手术顺利完成，患者随访（12.0±0.7）个月。后路组呼吸机使用时间、气管插管时间均少于前路组，差异有统计学意义（P<0.05）；术后12个月，两组患者ASIA运动及感觉评分均较术前及术后2周显著改善，差异有统计学意义（P<0.05），两组间比较差异无统计学意义（P>0.05）。术后12个月，前路和后路组患者ASIA分级A级（12 vs.19）、B级（15 vs.16）例数差异无统计学意义（P>0.05）。前路组术后发生血肿1例，感染1例，脑脊液漏3例；后路组出现脑脊液漏1例，深静脉血栓1例。结论 前路椎体次全切除术与后路全椎板切除术治疗颈椎脊髓损伤同样可恢复患者神经功能，后路全椎板切除可缩短呼吸机使用时间及气管插管时间。 |
| 关键词：颈椎 脊髓损伤 减压术,外科 脊柱融合术 内固定器 |
| Anterior corpectomy vs. posterior total laminectomy for treatment of cervical spinal cord injury Fulltext |
| LONG Zai-xian1 DAI Ye-hong1 XU Guang-hui2 LI Zhen-huan2 LIU Xiao-dong2 HONG Xiao-liang2 JIA Lian-shun3 |
1. Department of Orthopaedics, Xiushan County Branch Hospital of Second Affiliated Hospital of Chongqing Medical University, Chongqing 409900, China;
2. Department of Orthopaedics, Zhabei Branch of Changzheng Hospital, Second Military Medical University, Shanghai 200070, China;
3. Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China |
| Fund Project: |
| Abstract: |
| Objective To compare the clinical efficacy of anterior corpectomy and posterior total laminectomy for treatment of cervical spinal cord injury. Methods From January 2015 to January 2016,the clinical data of 76 patients with severe cervical spinal cord injury in Xiushan County Branch Hospital of Second Affiliated Hospital of Chongqing Medical University and Zhabei Branch of Changzheng Hospital were retrospectively analyzed. All the patients suffered from complete or incomplete paralysis,with American Spinal Injury Association(ASIA) grade A(complete paralysis,48 cases) or B(incomplete paralysis,28 cases). Thirty-four patients were treated by anterior corpectomy and fusion(anterior approach group),and 42 patients by posterior total laminectomy and fusion (posterior approach group). Ventilator support time,tracheal intubation time,pre-and post-operative ASIA motor and sensory scores and postoperative complications were compared between the 2 groups.Results All the patients were operated successfully,and followed up for 12.0±0.7 month. The ventilator support time and tracheal intubation time in posterior approach group were shorter than those in anterior approach group,and the difference was statistically significant(P<0.05). Postoperative 12 months,ASIA motor and sensory scores of the 2 groups significantly improved compared with the preoperative and 2-week-postoperative those,and the difference was statistically significant(P<0.05);but there was no significant difference between the 2 groups(P>0.05). Postoperative 12 months,there was no significant difference between the 2 groups in ASIA grade A(12 vs. 19,P>0.05) and B(15 vs. 16,P>0.05). In the anterior approach group,there was 1 case of hematoma,1 case of infection,3 cases of cerebrospinal fluid leakage;in the posterior approach group,there was 1 case of cerebrospinal fluid leakage and 1 case of deep vein thrombosis. Conclusion Both anterior corpectomy and posterior total laminectomy can restore patients' neurological function. Posterior total laminectomy can shorten the ventilator support and tracheal intubation times. |
| Keywords:Cervical vertebrae Spinal cord injuries Decompression,surgical Spinal fusion Internal fixators |
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