多节段颈椎损伤的后路手术治疗方法探讨.doc

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1、多节段颈椎损伤的后路手术治疗方法探讨［摘要］目的评估颈后路单开门扩大椎板成形术结合侧块螺钉固定对于多节段颈椎管狭窄及创伤性颈脊髓损伤治疗的安全性及可行性。方法方便选取于该院2012年1月一2014年3月收治的22例行颈后路单开门扩大椎板成形术结合侧块螺钉固定术的多节段颈椎管狭窄及不稳定骨折并发脊髓损伤的患者进行回顾性研究，通过术后J0A评分的改善及并发症的发生评估手术效果。结果平均手术时间120min,平均出血量445inL,从C3-C7共有128枚侧块螺钉置入，包括C3:22枚，C4：36枚，C5：38枚，C6：22枚，C7：10枚。平均术前J0A评分(3・26±0・64)分，

2、所有患者平均随访16.5个月，平均术后J0A评分(&21±1.37)分，明显高于术前水平(t二1.871,P<0.05),平均改善率(46.5±9.8)%。5例患者出现术后并发症，包括脑脊液漏、伤口延迟愈合、肺部感染及泌尿系感染。经治疗后其中1例术示1月死丁•呼吸功能衰竭。结论颈后路单开门扩人椎板成形术结合侧块螺钉固定对于多节段颈椎管狭窄及创伤性颈脊髓损伤的治疗是可行的，其优点包括手术创伤小，术中出血少，操作安全，对于骨折提供可靠地稳定性。［关键词］椎板成形术；脊髓损伤；椎管狭窄［屮图分类号］R687.3［文献标识码］A［文章编号］1674-0742(2016)10(c)-005

3、6-04[Abstract]ObjectiveToevaluatethesafetyandfeasibilityofopen-doorexpansive1aminoplastyincombinationwithlateralmassscrewfixationforthetreatmentofmultilevelcervicalspinalstenosisandspinalcordinjuryinthetraumapopulation.MethodsConvenientseiectionthiswasaretrospectivestudyof22patientswhohadmult

4、ilevelcervicalspinalstenosisandspinalcordinjurywithunstablefracturefromJanuary2012toMarch2014inourhospita1.Anopen-doorexpansiveposterior1aminoplastycombinedwithlateralmassscrewfixationwasperformedunderpersistentintraoperativeskul1tFaction.OutcomemeasuresincludedpostoperativeimprovementinJapan

5、eseOrthopedicAssociation(JOA)scoreandincidenceofcomplications.ResultsTheaverageoperationtimewas120min,withanaveragebloodlossof445ml.Atotalof128lateralmassscrewswereimplantedintothecervicalvertebraebetweenvertebralC3andC7,ineluding22intoC3,36intoC4,38intoC5,22int0C6,and10intoC7・Themeanpreopera

6、tiveJOAscorewas(3.26±0.24)points.Thepatientswerefollowedforanaverageof16.5months,andtheaverageJOAscoreimprovedto(8.21±1.37)points,significantlyhigherthanthepreoperativescore(t二1.871,P<0.05),withanaverageimprovementof(46.5±9.8)%・Postoperativecomplicationsinfivepatientsincludedcerebrospinalflui

7、dleakage,delayedwoundhealing,pulmonaryinfection,andurinaTysysteminfection.onediedfromrespiratoryfailure1monthspostoperatively.ConclusionTheopen-doorexpansive1aminoplastycombinedwithposteriorlateralmassscrewfixationisfeasiblefortreatingmultile