颈椎过伸性损伤后行颈前路椎体次全切植骨融合内固定治疗的临床效果研究分析  

A clinical analysis of the anterior cervical corpectomy and fusion internal fixation for the patients with cervical hyperextension injury

作　　者：张玉良[1] 周杨[1] 陆建强[1] 

机构地区：[1]嘉兴武警浙江省总队医院骨一科,浙江嘉兴314000

出　　处：《中国急救医学》2016年第10期943-947,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的研究分析颈椎过伸性损伤后行颈前路椎体次全切植骨融合内固定治疗的临床疗效。方法本研究回顾性分析2012—05—2014—02我院收治的62例颈椎过伸性损伤患者行颈前路椎体次全切除减压植骨融合术治疗者3l例（观察组），行颈后路减压植骨内固定者31例（对照组），观察两组患者术前、术后8个月的Frankel分级恢复情况；并根据患者术前年龄分段、MRI分型等因素于术后8个月对两组患者进行JOA评分评估。结果62例患者手术均成功，术中无神经、血管、脊髓损伤。2例于术后1h发生神经功能障碍加重情况，急诊行手术发现椎管内血肿脊髓受压，重新清除血肿，术后患者神经功能均有所提高。治疗医师对所有患者通过上门或门诊方式对所有患者均行随访，时间7～20个月，平均（8．87±3．12）个月；术后随访发现，两组组内比较，〈55岁患者术后临床疗效显著高于大于等于55岁患者，差异具有统计学意义（P〈0．05）；观察组术前〈55岁和355岁患者的临床疗效评分比较差异无统计学意义（P〉0．05），观察组〈55岁和355岁患者术后8个月、JOA改善分数均显著高于对照组，差异具有统计学意义（P〈0．05）；两组患者术后随访并进行组内比较，术前MRI检查分型中，Ⅰ型患者术后效果显著高于Ⅱ型和Ⅲ型患者，Ⅱ型患者术后效果显著高于Ⅲ型患者，差异具有统计学意义（P〈0．05）；两组组间比较，观察组术后8个月和JOA改善分数Ⅰ型、Ⅱ型患者术后效果均显著优于对照组，但Ⅲ型两组术后效果差异无统计学意义（P〉0．05）。结论颈前路椎体次全切除减压植骨融合内固定术治疗颈椎过伸性损伤患者可有效缩短手术时间、降低术中创伤，术后并发症发生率低，患者整体临床疗效恢复更好，适合临床医师广泛应用。Objective To analyze the treatment efficacy of anterior cervical corpectomy and fusion fixation for the patients with cervical hyperextension injury. Methods This retrospective analysis included 62 cervical hyperextension injury patients who admitted to our hospital from May 2012 to February 2014. These patients were divided into observation group and control groups with 31 patients in each group. Patients in observation group were treated by anterior corpectomy decompression and fusion; patients in control group were treated by the line posterior decompression and bone graft fixation. The two groups were observed before surgery, Frankel grade after eight months of recovery ; and according to age, preoperative staging, MRI classification and other factors in the two groups after 8 months in patients with JOA score evaluation. Results Sixty - two patients were operated successfully without nerves, blood vessels, spinal cord injury during the surgery. One hour after surgery, 2 cases occurred aggravated postoperative neurological dysfunction; the two patients were found spinal cord compression hematoma by emergency surgery and removal of the hematoma improved postoperative neurological function. All the patients were followed up through the door or out - patient basis by treating physicians for 7 - 20 months, an average follow up of（8.87 ± 3.12 ） months. Postoperative follow - up found in both groups, clinical efficacy in patients less than 55 years old was significantly higher than that in patients greater or equal to 55 - year - old, the difference was statistically significant （P 〈 0. 05 ）. Before surgery, in the observation group there was no significant difference in clinical efficacy scores between the patients less than 55 years old and ≥ 55 years old （ P 〉 0. 05 ） ; 8 months after surgery, JOA scores improved significantly higher in patients less than 55 years old when compares with the patients who were≥ 55 years old （ P 〈 0.05 ）. The postoperative follow - up found the clinical e

关 键 词：颈椎过伸性损伤 颈前路椎体次全切 植骨融合内固定 

分 类 号：R473.6[医药卫生—护理学]