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时间:2020-05-24
《三种手术方法治疗脊髓型颈椎病的临床疗效本科临床医学论文设计下载.doc》由会员上传分享,免费在线阅读,更多相关内容在工程资料-天天文库。
1、临床医学论文•三种手术方法治疗脊髓型颈椎病的临床疗效作者:刘艳兵,申勇,杨大龙,李志远,王林峰【摘要][目的]探讨脊髓型颈椎病(CSM)的三种不同手术方式疗效。[方法]对2002年6月〜2007年12月间在本院因CSM行颈椎手术治疗的患者111例,A组颈椎前路椎体次全切减压植骨融合内固定术54例;年龄44〜75岁,平均57.1岁。B组颈椎后路单开门椎管扩大成型术33例;年龄41〜73岁,平均61岁。C组颈椎后前路联合手术24例;年龄48〜78岁,平均62岁。依据随访结果,比较术前、术后随访时JOA评分,颈椎弧度,进行分析研究。[结果]患者定期随访,时间3个月〜5年,平均
2、2年,三组患者术后3、6、12个月及最后一次随访JOA评分与术前比较,差异有统计学意义(P<0.05),各组间比较差异无统计学意义(P>0.05)。颈椎D值术后即刻与半年、末次随访时A、C两组组间无统计学差异(P值分别为P=0.434,P=0.492,P=0.569),B组与另两组均有统计学差异(P均<0.05)4结论]脊髓型颈椎病根据受压部位、病变范围选用不同的三种手术方式均能达到有效的治疗。前路和后前路联合手术能较好的恢复和维持颈椎生理弧度;后路术后颈椎弧度部分丢失。【关键词】颈椎病;手术方法;临床疗效Abstract:[Objective]Toexplorethe
3、therapeuticeffectofthreesurgicalprocedures(anteriorapproach,posteriorapproachandposterior-anteriorapproach)forcervicalspondyloticmyelopathy(CSM).[Methods]Atotalof111patientswithcervicalspondyloticmyelopathytreatedwiththreesurgicalproceduresfromJune2002toDecember2007wereretrospectivelyana
4、lyzed.GroupA(anteriorapproach)comprised54patientswithameanageof57.1years(ranged,44〜75years).GroupB(posteriorapproach,Laminoplasty)comprised33patientswithameanageof61years(ranged,41〜73years).GroupC(posterior-anteriorapproach)comprised24patientswithameanageof62years(ranged,48-78years).Al1p
5、atientswerefollowed-up,neuralfundionandcervicalsagittaialignmentwererecorded.AccordingtoJOAscore,preoperativeandpostoperativefollow-upscoreswerecompared,improvementrateswerecalculated,respectively.[Results]Patientswerefollowedupfor3monthsto5yearswithanaverageof2years.JOAscoresofthethreeg
6、roupsat3,6,12monthsandatthelastfollow-upafteroperationwerecomparedwiththoseofpreoperation(P<0.05)•Therewasnosignificanldifferenceamongthethreegroups(P>0.05).Cervicalsagittaialignment(Dnumericalvalue)hadnostatisticaldifferenceatthepostoperativeandthefinalfollow-upbetweengroupAandgroupC(P二
7、0.434,P=0.492,P=0.569).TherewassignificantdifferencebetweengroupBandgroupA/C(P<0.05).[Conclusion]Similarneurologicalimprovementwasobtainedbyanterior,posteriororanterior-posterioraproachforCSM.Anterioroperationandanterior-posterioroperationarehelpfultoresumeandmaintainthes
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