临床医学论文颈椎前路椎间融合术后邻近节段的病变研究.doc

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1、临床医学论文•颈椎前路椎间融合术后邻近节段的病变硏究作者:刘洪，HirokazuTshihara,智慧明【关键词】颈椎疾患摘要：〔冃的〕硏究颈椎前路椎间融合术后症状性邻近节段病变的发生率以及预测其发生的因素。〔方法〕112例颈椎间盘突出症或颈椎病接受颈椎前路椎体间融合术患者，行术后症状的评价，神经学检查及系列放射学检查，分析症状性邻近节段病变的发生率与临床和影像学参数的关系。症状性邻近节段病变的发生率通过KnpldnMcicT生存分析法进行统计，各参数与症状性邻近节段病变的发生率之间的关系通过u检验和t检验分析。〔结果〕随访时间2~19a，平均

2、94a。112例患者中有19例(17%)出现了症状性邻近节段病变，其中男12例,女7例oRaplanMeier生存分析法分析未出现症状邻近节段病变的患者比率，5a时比率为89%»10a时为84%，17a时为67%。出现症状性邻近节段病变的病例•I'，术前脊髓造影上邻近节段硬膜有明显压迹或MRI上邻近节段椎间盘突出的发生率明显高于未出现症状性邻近节段病变的病例(P分别为00087及00299，双样本t检验)。而其他参数没有显著性差异。7名患者因保守治疗无效而进行了手术。〔结论〕当术前脊髓造影或MRI显示该节段存在无症状性椎间盘退变吋，颈椎前路椎体

3、间植骨融合术后症状性邻近节段病变的发牛率明显高，与融合的节段数、术前颈椎曲度、椎管的直径或融合节段的曲度都无关。关键词：颈椎疾患；椎体间融合术后；邻近节段病变Abstract:[Objective]Thepresentstudywasundertakentoinvestigatetheincidenceofsymptomaticadjacentsegmentdiseaseafteranteriorcervicalinterbodyfusion(ACIF)用ndtoidentifythefactorswhicharcrelatedtothedev

4、elopmentofthisdisease〔Method〕From1981to1997,atotalof160patientsunderwentanteriorcervicalinterbodyfusionforintervertebraldischerniationandcervicalspondylosisAtotalof112patientswerefollowedupclinicallyandradiologicallyformorethantwoyearsOfthem,74weremenand38werewomen,theaverag

5、eagealoperationwas51years(ranged,31-70years)Ofthe112patients,66hadone,44hadtwoand2hadthreelevelsoffusionFollowupevaluationwasprimarilyviaclinicalvisitedThepostoperativecourseofanysymptoms,thefindingsofneurologicalexaminationandserialfollowupradiographswereperformedinal1patie

6、ntsThediagnosisofsymptomaticadjacentsegmentdiseasewasbasedonthepresenceofnewradiculopathyormyelopathysymptomsreferabletoanadjacentlevel,andthepresenceofacompressivelesionatanadjacentlevelbymagneticresonanceimagingormyelographyWeevaluatedthecorrelationbetweentheincidenceofsym

7、ptomaticadjacentsegmentdiseaseandthefollowingclinicalparameters(ageatoperationsex,numberofthelevelsfused)andradiologicalparameters(preoperativecervicalspinealignment^preoperativerangeofmotionofC2~7cervicalspine,anteroposteriorspinalcanaldiameter,preoperativeexistenceofanadja

8、centsegmentdegenerationonplainradiograph,mye1ographyandmagneticresonanceima