颈前路融合术后邻近节段退行性改变的研究进展

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1、授予单位代码10089学号或申请号20153371中国图书分类号R681.5HebeiMedicalUniversity硕士学位论文专业学位颈前路融合术后邻近节段退行性改变的研究进展研究生：高艳龙导师：申勇教授专业：外科学二级学院：第三医院2018年3月目录中文摘要············································································································1英文摘要·····················································

2、·······················································2英文缩写············································································································4综述颈前路融合术后邻近节段退行性改变的研究进展····························5参考文献··········································································

3、································14致谢··················································································································22个人简历··········································································································23中文摘要颈前路融合术后邻近节段退行性改变的研究进展摘要颈椎病是最常见的

4、骨科疾病之一，近年来，随着人们生活方式和工作环境的改变，其发生率逐渐升高，患者年龄也越来越年轻化。在各种类型的颈椎病中，以脊髓型颈椎病和神经根型颈椎病较常见，由于颈椎间盘退变，导致颈部脊髓受压，出现上肢疼痛及神经功能障碍，严重影响患者的生存质量。目前，治疗颈椎病的主要手段是手术治疗，对于短节段的神经根型和脊髓型颈椎病，大多数骨科医生采用颈前路椎间盘切除植骨融合内固定术（Anteriorcervicaldiscectomyandfusion,ACDF），解除神经压迫，达到治疗疾病的效果。然而，很多接受此手术治疗的患者，术后出现邻近节段退行性改变。邻近节段退行性改变（AdjacentSegmen

5、tDegeneration，ASD）指正常节段由于相邻节段融合而产生局部应力增加所导致该正常节段的退变，严重患者术后的生活质量下降，部分患者甚至需要行二次手术治疗。ASD已引起越来越多临床医生的关注。目前，对于ASD的发生机制并无统一定论。通过查阅相关文献，就其发病率、发病机制及相关因素等综述如下。通过总结相关文献，ASD的可能相关因素包括：年龄及性别，融合节段的数量及位置，椎管大小，椎间隙高度，术前、术后颈椎曲度，颈椎运动范围(TheRangeOfMotion,ROM)，钢板边缘至手术节段椎体边缘的距离（PlatetoDiscDistance,PDD)，术前早已存在的退变等。术者应对患者进

6、行充分的评估，术中尽量避免上述情况，可明显减少ASD的发生率。关键词：神经根型颈椎病，脊髓型颈椎病，颈前路减压植骨融合内固定术，邻近节段退行性改变，相关因素，综述文献1英文摘要ResearchprogressofadjacentsegmentdegenerationafteranteriorcervicaldiscectomyandfusionABSTRACTCervicalspondylosisisoneofthemostcommonorthopaedicdiseases.Inrecentyears,theincidenceofcervicalspondylosisgraduallyinc

7、reasedwiththechangeofpeople'slifestyleandworkingenvironment,andtheageofonsetisalsoyounger.Amongalltypesofcervicalspondylosis,myelopathyandradiculopathyaremorecommon.Duetothedegenerationofcervicalinterverteb