颈椎单开门椎管扩大成形术不同椎板固定方法治疗多节段脊髓型颈椎病的临床研究.doc

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1、颈椎单开门椎管扩大成形术不同椎板固定方法治疗多节段脊髓型颈椎病的临床研究［摘要］目的分析颈椎单开门椎管扩大成形术(CL)两种不同椎板固定方法治疗多节段脊髓型颈椎病(CSM)的临床效果。方法选择2009年7月〜2013年7月在我院接受手术多节段CSM患者80例，分为采用微型钛板固定的观察组和采用传统的丝线悬吊方法固定的对照组，每组各40例。比较两组患者手术时间、术中出血量、术后1周的J0A评分等。结果两组的手术时间、术中出血量差异不显著(卩均>0.05)；观察组术后1周的J0A评分［(10.32±2.

2、18)］高于对照组［(9.01土1.09)］,观察组患者改善率225%有36例，高于对照组的28例；观察组并发症发生率为7.50%,明显低于对照组的25.00%(P<0.05)o结论CL术结合微型钛板内固定方法治疗多节段CSM术后疗效良好，且并发症少，值得推广。［关键词］椎管扩大成形术；脊髓型颈椎病；微型钛板固定［中图分类号］R687.3［文献标识码］A［文章编号］1673-9701(2015)08-0012-03［Abstract.］ObjectiveToanalyzetheclinicaleff

3、ectsoftwofixingapproachesofvertebralplateincervicalvertebraopen-doorexpansive1aminoplastyinthetreatmentofmulti一segmentalcervicalspondyloticmyelopathy(CSM)•MethodsEightypatientswithmulti-segmentalCSMwhoreceivedsurgeryinourhospitaifromJuly2009andJuly2013

4、wereselected.Theywereallocatedtoanobservationgroupwhoreceivedfixationofminiaturetitaniumplatesandacontrolgroupwhoreceivedconventionalapproachofsilkhanging,40patientsineachgroup.Surgicaltime,volumeofbleedingduringsurgery,andJOAscores1weekafterthesurgery

5、inthetwogroupswerecollected.ResultsSurgicaltimeandvolumeofbleedinginthetwogroupswerenotstatisticallysignificant(allP>0.05)；JOAscores1weekafterthesurgery[(10.32±2.18)]intheobservationgroupwashigherthanthat[(9.01±1.09)]inthecontrolgroup・Improvementrateof

6、36patientsintheobservationgroupwas三25%,andthenumberofpatientswasmorethanthatof28patientsinthecontrolgroup；incidenceofcomplicationsintheobservationgroupwas7.50%,significantly1owerthanthatof25.00%inthecontrolgroup(1X0.05)•ConclusionExpansivelaminoplastyc

7、ombinedwithfixationofminiaturetitaniumplatesinthetreatmentofmulti-segmentalCSMhasafavorablepostoperativeeffectandrarecomplications,whichisworthyofclinicalpromotion.[Keywords]Expansive1aminoplasty；Cervicalspondyloticmyelopathy(CSM)；Fixationofminiatureti

8、taniumplates脊髓型颈椎病(cervicalspondyloticmyelopathy,CSM)是一种由丁颈椎或其他相邻组织出现退行性改变，突出的颈椎间盘或骨赘引起和血管慢性压迫，进而产生脊髓神经的感觉、运动、反射及排便功能障碍［1］。CSM占颈椎病的10%〜15%,多发于40〜60岁，常表现为：手足无力、活动不灵活、行走不稳，手持物易坠落，有时感四肢麻木，严重者可出现二便困难或失禁，甚至发生四肢痉挛性瘫痪［2］。“单开门”椎管扩人术是一种安全有效的治疗颈椎