颈前路减压融合术后假关节形成因素分析及对远期疗效影响  

Clinical observation and evaluation of resaons for pseudarthrosis after anterior cervical fusion

作　　者：徐广辉[1] 陈雄生[2] 史建刚[2] 贾连顺[2] 

机构地区：[1]上海长征医院闸北分院骨科,200070 [2]上海长征医院骨科

出　　处：《中华医学杂志》2013年第3期200-203,共4页National Medical Journal of China

摘　　要：目的探讨颈前路减压髂骨融合术后假关节形成的影响因素，以及对神经功能和颈部轴性症状的影响。方法回顾性分析2000年3月至2006年11月于长征医院和长征闸北分院骨科收治行颈前路减压植骨融合术412例，观察骨密度、髂骨植骨块修剪及放置情况、终板处理、颈托固定时间及规范使用、吸烟史等。以颈椎屈伸侧位片判断是否有假关节出现。采用日本骨科学会（JOA）评分法评价神经功能的变化。临床随访期平均达到5．4年。对患者颈部疼痛等症状以视觉模拟评分（VAS）进行定量评分。采用SPSS13．0统计软件对假关节及融合组影响因素、神经功能评分、颈部轴性症状发生率进行对比统计分析。结果37例颈椎融合节段出现了假关节，假关节组与融合组（375例）骨质疏松分别出现30、119例，有效外固定25、43例，吸烟史26、87例，软骨终板点状出血分别为18、340例（P〈0．05），而植骨块为三面皮质骨25、260例（P〉0．05）。术前及术后5年JOA评分差异有统计学意义。假关节组与融合组比较，神经功能改善率差异有统计学意义（70．2％比50．7％，P〈0．05）。37例中26例出现颈痛、活动受限等不适症状，无假关节形成仅89例出现颈痛等不适症状，二组VAS评分差异有统计学意义（286、89比11、26，P〈0．05）。结论假关节形成与患者骨质疏松、软骨终板处理不当、局部外固定时间过短或不规范、吸烟有关，假关节形成对术后远期神经功能产生影响、与颈部疼痛等有关。Objective To explore the causes of pseudarthrosis and evaluate the clinical neurological function and neck subaxial symptoms after anterior cervical fusion. Methods A total of 412 patients were followed up with an average of 5.4 years. The bone mineral density, bone graft trimming and placement, management of endplate, smoking and neck support fixation time were observed. Japanese Orthopedic Association （JOA） score was used to evaluate the changes of neurological functions and clinical outcomes. Visual analog scale （VAS） score was used to evaluate the neck subaxial symptoms. And pseudarthrosis was examined by flexion-extension radiography. SPSS statistical software 13.0 was used to evaluate the differences of JOA and VAS scores between pseudarthrosis and control groups. Results Among them, 57 cases of pseudarthrosis were observed. There were osteoporosis （n =30 vs n = 119）, cartilage end- plate punctuate hemorrhage （n = 18 vs n = 340）, 25 and 43 cases with ineffective cervical external fixation （n = 25 vs n = 43） and smoking （n = 26 vs n = 87） in pseudarthrosis and fusion groups respectively. Significant differences existed in the above-mentioned indices between two groups. However, no signficant difference existed in bone graft shape between two groups. There were significant differences in JOA and VAS scores between two groups. Conclusion The causes of pseudarthrosis included decreased bone density, osteoporosis, over-curette of endplate, shortness of neck support fixation time and smoking. And pseudarthrosis may influence the long-term recovery of neurological functions or it is correlated significantly with neck symptoms.

关 键 词：颈椎 骨移植 脊柱融合术 假关节 神经功能 

分 类 号：R687.3[医药卫生—骨科学]