颈椎椎弓根螺钉固定结合单开门椎管扩大成形治疗颈椎管狭窄伴无骨折脱位型颈脊髓损伤的临床研究

《颈椎椎弓根螺钉固定结合单开门椎管扩大成形治疗颈椎管狭窄伴无骨折脱位型颈脊髓损伤的临床研究》由会员上传分享，免费在线阅读，更多相关内容在学术论文-天天文库。

1、中图分类号：R89；R36；R39硕士学位论文颈椎椎弓根螺钉固定结合单开门椎管扩大成形治疗颈椎管狭窄伴无骨折脱位型颈脊髓损伤的临床研究院（系）、所临床医学院研究生姓名罗彬学科、专业外科学导师姓名王清教授二Ο一二年四月目录1颈椎椎弓根螺钉固定结合单开门椎管扩大成形治疗颈椎管狭窄伴无骨折脱位型颈脊髓损伤的临床研究„„„„„„„11.1中文摘要„„„„„„„„„„„„„„„„„„„„„11.2英文摘要„„„„„„„„„„„„„„„„„„„„„31.3前言„„„„„„„„„„„„„„„„„„„„„„„51.4材料与方法„„„

2、„„„„„„„„„„„„„„„„„71.5结果„„„„„„„„„„„„„„„„„„„„„„„121.6讨论„„„„„„„„„„„„„„„„„„„„„„„241.7结论„„„„„„„„„„„„„„„„„„„„„„„301.8参考文献„„„„„„„„„„„„„„„„„„„„„311.9英汉缩略词对照表„„„„„„„„„„„„„„„„„352致谢„„„„„„„„„„„„„„„„„„„„„„„363无骨折脱位型颈脊髓损伤的诊治进展（综述）„„„„„392颈椎椎弓根螺钉固定结合单开门椎管扩大成形治疗颈椎管狭窄伴无骨折脱位型颈脊

3、髓损伤的临床研究摘要目的：探讨颈椎椎弓根螺钉固定结合单开门椎管扩大成形治疗颈脊髓前方无局限性压迫、颈椎节段性不稳的颈椎管狭窄伴无骨折脱位型颈脊髓损伤的临床疗效。方法：2006年6月~2011年3月纳入44例颈椎管狭窄伴无骨折脱位型颈脊髓损伤患者，男28例，女16例；年龄34—71岁，平均51.7±8.2岁；Brown-Sequard综合症4例,前脊髓损伤综合症12例，脊髓中央综合症26例，其他2例；术前采用日本骨科学会关于颈脊髓损害的功能评定标准（JOA17分法）评分4-13分，平均7.2±2.3分。采用颈椎椎弓根螺

4、钉内固定结合单开门椎管扩大成形治疗；以JOA脊髓功能评分并计算改善率评估脊髓功能，X线片、CT及MRI评估颈椎曲度、稳定性、内固定位置及椎管扩大情况。结果：所有患者均顺利完成手术，手术时间100-180分钟，平均130±15.5分钟；失血150-600ml，平均250±48.5ml。所有患者无切口感染、无血管神经损伤等并发症发生，1例患者术后第4天因肺栓塞死亡，40例患者随访12-60个月，平均25.2±17.6个月，3例失访，末次随访时JOA脊髓功能评分改善率为68.5%，双上肢功能恢复较差并双手不同程度肌肉萎缩5

5、例，其中2例术后15月、19月因脊髓功能恢复不佳考虑颈脊髓前方局限性受压再次行颈前路脊髓减压植骨融合内固3定，术后脊髓功能障碍进一步恢复；发生轴性症状患者5例。X线片检查显示颈椎曲度良好，无断钉、断棒及颈椎不稳定；CT检查显示螺钉位置良好，椎管扩大成形满意，无门轴断裂及再关门。结论：颈椎椎弓根螺钉固定结合单开门椎管扩大成形治疗颈脊髓前方无局限性压迫、颈椎节段性不稳定的颈椎管狭窄伴无骨折脱位型颈脊髓损伤持续扩大了颈椎管，固定融合了颈椎不稳定节段，避免了经颈前路手术时喉上、喉返神经、食道、气道及颈部大血管等重要解剖结构损

6、伤，减少了气道梗阻、呼吸道感染发生率，可取得满意的神经功能恢复，且轴性症状发生率低，颈椎曲度部分恢复，该术式可操作性强，有一定适应症。关键词：颈脊髓损伤；颈椎管狭窄；椎管扩大成形；椎弓根螺钉固定4Posteriorexpansiveopen-doorlaminoplastyandpediclescrewfixationforcervicalspinalcordinjurywithspondylostenosisandwithoutradiologicalabnormalityAbstract:bjective:Toi

7、nvestigatetheclinicalefficacyofposteriorexpansiveopen-doorlaminoplastyandpediclescrewfixationforcervicalspinalcordinjurywithoutfractureanddislocationinpatientswithcervicalstenosis.Methods:BetweenJune2006andJanuary2012,44patients（28malesand16females.）,themeanage

8、of51.7±8.2rears(range,34-71years)withcervicalspinalcordinjurywithcervicalstenosisbutwithoutfractureordislocationinplainfilmswereincludedtoreceiveposteriorC3toC7expansiveopen