神经根型颈椎病伴无症状退变性颈脊髓压迫治疗方法的讨论  

Therapeutic method of cervical spondylotic radiculopathy with asymptomatic degeneration of cervical spinal cord compression

作　　者：王晓林[1] 陈芳[1] 曾凡伟[1] WANG Xiaolin;CHEN Fang;ZENG Weifan(Department of orthopaedics, Dazhou Central Hospital, Dazhou 635000,China)

机构地区：[1]达州市中心医院骨科

出　　处：《现代仪器与医疗》2019年第3期65-68,共4页Modern Instruments & Medical Treatment

摘　　要：目的:探讨神经根型颈椎病(CSR)伴无症状退变性颈脊髓压迫(A-SCCC)的治疗方法,总结临床诊治原则。方法:病例来源于我院2013年8月至2018年2月收治的神经根型颈椎病患者,影像学检查发现退变性颈脊髓压迫。患者均于我院接受综合治疗,以仰卧前屈拔伸牵引为主,辅以颈椎手法治疗、颈椎制动、针刺等,持续2周,若患者治疗期间神经功能持续恶化或疼痛剧烈无法缓解,则实施外科干预。记录患者疼痛视觉模拟评分(VAS)、颈椎日本骨科学会(JOA)评分变化,以及外科手术干预情况,讨论CSR伴A-SCCC的临床治疗方案。结果:150例患者中,31例行手术治疗,术后恢复良好,其余119例均顺利完成非手术治疗。非手术治疗患者治疗后2周VAS评分较治疗前下降,颈椎JOA评分较治疗前升高,差异有统计学意义(P<0.05),患者治疗后2周、治疗后6个月VAS评分、颈椎JOA评分比较,差异无统计学意义(P>0.05)。末次随访时,119例非手术治疗患者总有效率为79.83%(95/119),手术组总有效率87.09%(27/31)。结论:对于多数CSR伴A-SCCC患者,非手术综合治疗可取得满意的治疗效果,但对于出现颈椎局部症状、脊髓压迫严重、颈椎过度活动者,应考虑开展外科手术干预。Objective: This study objective was to explore the treatment of radiculocervical spondylosis (CSR) with asymptomatic degenerative cervical and spinal cord compression (A-SCCC), and summarize the principles of clinical diagnosis and treatment. Methods: The cases were from patients with radiculocervical spondylopathy admitted to our hospital from August 2013 to February 2018, and their imaging examination showed that the degenerative cervical spinal cord compression. All the patients received comprehensive treatment in our hospital, mainly supine anterior flexion, extension and traction, supplemented by cervical manipulation, cervical brake, acupuncture, etc., lasting for 2 weeks. If the neurological function of the patients continues to deteriorate or the pain cannot be alleviated, surgical intervention will be implemented. Changes of visual analogue score (VAS), Japanese Orthopaedic Assoc iation (JOA) score and surgical intervention were recorded to discuss the clinical treatment plan of CSR with A-SCCC. Results: Among the 150 patients, 31 underwent surgical treatment, and the postoperative recovery was good. VAS score of non-surgical patients decreased 2 weeks after treatment and JOA score of cervical vertebra increased compared with those before treatment, and the difference was statistically significant (P<0.05). Comparison of VAS score and JOA score of cervical vertebra at 2 weeks after treatment and 6 months after treatment showed no statistically significant difference (P>0.05). At the last follow-up, the total effective rate of 119 non-operative patients was 79.83%(95/119), and that of the operation group was 87.09%(27/31). Conclusions: For most CSR patients with a-sccc, non-surgical comprehensive treatment can achieve satisfactory therapeutic effect, but for patients with local cervical symptoms, severe spinal cord compression, and excessive cervical movement, surgical intervention should be considered.

关 键 词：神经根型 颈椎病 无症状 脊髓压迫 治疗 

分 类 号：R68[医药卫生—骨科学]