颈前路椎间盘切除植骨融合内固定术治疗颈椎管狭窄患者颈椎挥鞭样损伤的疗效评价  

Evaluation of the curative effect of anterior cervical discectomy and fusion in treating cervical whiplash injury in patients with spinal canal stenosis

作　　者：章凯 蔡凯文 罗科锋[1] 卢斌[1] 张威 陆继业[1] 蒋国强[1] ZHANG Kai;CAI Kaiwen;LUO Kefeng(Department of Spine Surgery,the Affiliated Hospital of Medical School of Ningbo University,Ningbo,315020,China)

机构地区：[1]宁波大学医学院附属医院脊柱外科,宁波市315020

出　　处：《中国脊柱脊髓杂志》2023年第5期441-447,共7页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨颈前路椎间盘切除植骨融合内固定术治疗因颈椎间盘突出致颈椎管狭窄患者遭受颈椎挥鞭样损伤的临床疗效。方法:回顾性分析2010年1月~2018年12月在我院行颈前路颈椎间盘切除植骨融合内固定术的50例颈椎挥鞭样损伤患者的临床资料,其中男32例,女18例,年龄35~75岁(53.6±13.6岁)。根据术前颈椎MRI T2加权相中矢状位上目标节段纤维性椎管最小矢状径分为狭窄组(最小矢状径≤13mm,32例)和非狭窄组(最小矢状径>13mm,18例),两组间年龄及性别无统计学差异。狭窄组随访25.6±7.4个月,非狭窄组27.4±8.3个月,两组随访时间差异无统计学意义。记录两组患者术前及术后1个月、1年及末次随访时ASIA评分的总分、感觉评分、运动评分,计算术后1个月、1年及末次随访时的日本骨科协会(Japanese Orthopedic Association,JOA)评分改善率和末次随访时的手术改善率,记录相关并发症的发生情况。结果:ASIA评分总分,每组术后各时间点与术前比较均有显著性增加(P<0.05);术前和术后1个月时两组间差异均无统计学意义,但术后1年及末次随访时差异均有统计学意义(P<0.05)。ASIA上肢运动评分,每组术后各时间点与术前比较均有显著性增加(P<0.05),术前及术后各时间点两组间比较差异均有统计学意义(P<0.05)。ASIA下肢运动评分,每组术后各时间点与术前比较均有显著性增加(P<0.05),术前及术后各时间点两组间比较差异无统计学意义(P>0.05)。ASIA感觉评分,每组术后各时间点与术前比较均有显著性增加(P<0.05);术前两组间差异无统计学意义(P>0.05),术后各时间点两组间比较差异有统计学意义(P<0.05)。每组患者术后各时间点JOA评分与术前相比均明显改善(P<0.05)。术后1个月狭窄组与非狭窄组JOA评分改善率分别为37.3%和55.9%,术后1年分别为61.3%和73.6%,末次随访分别为77.3%和91.1%,上述各时间点两组间比较差异有统�Objectives:To investigate the clinical efficacy of anterior cervical discectomy and fusion in treating cervical whiplash injury in patients with cervical spinal canal stenosis caused by cervical disc herniation.Methods:The clinical data of 50 patients with whiplash injury of the cervical spine who were treated in our hospital from January 2010 to December 2018 with anterior cervical discectomy and fusion were retrospectively analyzed.There were 32 males and 18 females,aged 35-75 years(53.6±13.6 years).According to the minimum sagittal diameter of fibrous spinal canal at the target segment in the sagittal position on MRI T2WI before surgery,the patients were divided into stenosis group(minimal sagittal diameter≤13mm,32 patients)and non-stenosis group(minimal sagittal diameter>13mm,18 patients).There were no statistical differences in age and gender between the two groups.No significant difference of follow-up was found between the stenosis group(25.6±7.4 months)and non-stenosis group(27.4±8.3 months).The total American Spinal Injury Association(ASIA)score,sensory score,and motor score before operation and at postoperative 1 month and 1 year and final follow-up were recorded;the improvement rate of Japanese Orthopedic Association(JOA)score at postoperative 1 month and 1 year and final follow-up,and surgical improvement rate at final follow-up were calculated;and the occurrence of related complications were recorded.Results:The total ASIA scores at postoperative 1 month,1 year and final follow-up in the two groups were statistically different from those before operation(P<0.05),respectively;there were no significant differences between the two groups at preoperation and 1 month after operation(P>0.05)and there were significant differences between groups at postoperative 1 year and final follow-up(P<0.05).The ASIA motor scores of the upper extremity at postoperative time points increased significantly than those before operation in both groups respectively(P<0.05),and there were statistical differences between g

关 键 词：颈脊髓损伤 颈前路颈椎间盘切除植骨融合内固定术 颈椎间盘突出 挥鞭样损伤 颈椎椎管狭窄 

分 类 号：R683.2[医药卫生—骨科学] R687.3[医药卫生—外科学]