康复治疗对后、前路联合手术治疗重症脊髓型颈椎病的临床意义  

The clinical significance of rehabilitative treatment for severe cervical spondylotic myelopathy after surgery

作　　者：杨大龙[1] 申勇[1] 曹俊明[1] 董玉昌[1] 孟宪国[1] 丁文元[1] 孟宪中[1] 张为[1] 李宝俊[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄050051

出　　处：《中华物理医学与康复杂志》2008年第9期622-625,共4页Chinese Journal of Physical Medicine and Rehabilitation

基　　金：河北省科技支撑计划项目（052761182）

摘　　要：目的探讨手术前、后康复治疗对后、前路联合手术治疗重症脊髓型颈椎病的临床意义。方法选择54例重症脊髓型颈椎病患者，平均年龄59．5岁，分为康复组（28例）和对照组（26例）。2组患者均先行颈后路单开门椎管扩大椎板成形手术，术后7～10d再行二期颈前路椎间盘切除植骨融合术，康复组于手术前、后进行系统的康复治疗。术后平均随访38．7个月。采用日本矫形外科协会（JOA）评分评定2组患者神经功能恢复情况，评估2组患者颈椎轴性症状的发生情况，观察2组患者手术伤口愈合情况及术后并发症。结果康复组患者伤口术后均一期愈合，无感染等并发症发生；对照组3例患者后路伤口感染，对症治疗后痊愈。前路术后，2组患者植骨均完全融合；康复组有2例、对照组有9例发生喉头水肿。2组术前JOA评分比较，差异无统计学意义（P〉0．05）；随访结束时，2组JOA评分均较术前有明显提高（P〈0．01），康复组评分明显优于对照组（P〈0．05）。康复组颈椎轴性症状发生率为25．0％，对照组为69．2％，2组差异有统计学意义（P〈0．01）。结论后、前路联合手术前、后进行系统的康复治疗有助于重症脊髓型颈椎病患者术后神经功能的恢复，并可以减少手术并发症及术后颈椎轴性症状的发生。Objective To evaluate the effectiveness of rehabilitative treatment for severe cervical spondylotic myelopathy after combined posterior-anterior surgery. Methods Fifty-four patients （ mean age, 59.5） who had undergone combined posterior-anterior surgery of the cervical spine due to severe cervical spondylotic myelopathy were studied with an average follow-up of 38.7 months. All the patients were allocated into either a rehabilitation treatment group （28 patients） or a control group （26 patients）. Neurological function in the two groups was assessed using the Japanese Orthopedic Association （JOA） grading system. In addition, the status of axial symptoms, wound healing and post-operative complications were also evaluated. Results The bone gratis completely fused in both groups. All of the wounds in the rehabilitation treatment group healed without any infection. Three wounds were infected in the control group, but were cured by prompt treatment. Two patients in the rehabilitation group and 9 in the control group suffered laryngeal edema. There was no significant difference between the two groups before the operation with regard to their JOA scores, which significantly increased postoperation in both groups. In the rehabilitation treatment group, the postoperation JOA scores were significantly higher than in the control group. At the same time, there were signifi- cantly fewer patients with neck axial symptoms in the rehabilitation treatment group than that in the control group （25.0% versus 69.2% , P 〈 0.01 ）. Conclusions Systematic rehabilitation treatment pre-and post-operation of patients with severe cervical spondylotie myelopathy can accelerate neurological recovery and help prevent postoperative complications and neck axial symptoms.

关 键 词：脊髓型颈椎病 后  前路联合手术 康复治疗 

分 类 号：R687.3[医药卫生—骨科学]