优先选择颈椎或腰椎手术治疗共存的颈腰椎椎管狭窄症:74例预后分析  

Cervical or lumbar surgery first for coexisting cervical and lumbar stenosis:a prognostic analysis in 74 patients

作　　者：李浩曦 沈彬[1] 黄宇峰[1] 张振[1] 赵卫东[1] 吴德升[1] 

机构地区：[1]上海市同济大学附属东方医院脊柱外科,上海200120

出　　处：《中国矫形外科杂志》2017年第11期961-966,共6页Orthopedic Journal of China

基　　金：国家自然基金资助项目(编号:81371994);浦东新区卫生系统重点学科建设资助(编号:PWZx2014-02)

摘　　要：[目的]证明优先选择颈椎或腰椎手术对治疗共存的颈腰椎椎管狭窄症患者症状改善更优。[方法]收集本院2000年1月~2014年12月随访时间>1年的共存颈腰椎管狭窄症患者74例,通过相关评价指标分别评估分期手术中优先选择颈椎或腰椎对预后的影响。[结果]随访18~156个月(58.00±36.50)个月。优先颈椎手术的腰椎再手术率比优先腰椎手术的颈椎再手术率低(22.91%<57.69%)(P<0.01)。优先颈椎手术JOA评分及Nurick分级较术前均显著改善(P<0.01),ODI评分较术前改善(P<0.05)。优先腰椎术后与术前相比,JOA评分及Nurick分级无明显改善(P>0.05),ODI评分明显改善(P<0.01)。[结论]治疗并存的颈腰椎椎管狭窄症患者,优先颈椎手术是安全有效的,在颈腰椎症状改善、肢体功能恢复及另一部位再次手术率方面优于优先腰椎手术。[Objective] To compare the outcomes of coexisting cervical and lumbar stenosis treated surgically with cervical procedure first versus lumbar one in priority. [Methods] Seventy-four patients with coexisting cervical and lumbar stenosis would receive staged surgical treatment from January 2000 to December 2014, including 48 patients had cervical procedure first and 26 patients underwent lumbar surgery in priority. The patients were followed up for more than 1 year, and evaluated for comparing efficacy of the two surgical strategies. [Results] The follow-up ranged from 18 months to 156 months with a mean of （58.00＋36.50） months. The lumbar reoperation rate after primary cervical surgery was lower than the cervical reoperation rate after lumbar surgery in priority （22.91% versus 57.69%, P〈0.01） . In the patients with cervical surgery came first, the JOA score and Nurick grade very significantly improved （P〈0.01） and the ODI score noticeably improved as well （P〈0.05） . Conversely, no obvious improvement in the JOA score and Nurick grade was noted in the patients who had lumbar surgery in priority （P〉0.05）, nevertheless the ODI score improved significantly （P〈0.01） . [ Conclusions ] For patients with coexisting cervical and lumbar stenosis, cervical surgery in priority is not only safe and effective, but also superior to lumbar surgery conducted firstly in the improvement of cervical and lumbar symptoms, the recovery of limb function and diminishing the reoperation on the corresponding site.

关 键 词：脊柱 共存的颈腰椎椎管狭窄症 全脊柱疾病 分期手术 手术顺序 

分 类 号：R687.3[医药卫生—骨科学]