摘要
目的研究70岁以上颈椎病患者的临床特征和前路手术治疗效果。方法采用回顾性分析,将20例70岁以上颈椎病患者作为老年组,将31例年龄小于69岁的多节段颈椎病患者作为对照组。两组均行前路减压植骨融合手术,应用日本骨科协会JOA评分系统进行疗效评价,比较两组的手术疗效和并发症发生情况。结果围手术期死亡1例,余50例随访24～55个月,平均35个月。老年组术前JOA评分平均9.3分(3～14分),终末随访时JOA评分平均13.4分(8～17分),优良率为68%,改善率为58%;对照组术前JOA评分平均11.0分(6～13分),终末随访时JOA评分平均14.8分(10～17分),优良率和改善率分别为71%和67%。两组比较优良率与改善率差异均无统计学意义(!2=0.04,P=0.85;t=1.12,P=0.138)。老年组有7例出现了手术相关并发症,并发症发生率为35%,高于对照组(3例,10%),但差异无统计学意义(!2=3.47,P=0.06)。术前颈椎过伸过屈侧位X线片显示老年组只有1例(5%)存在颈椎不稳,而对照组有8例(26%)颈椎不稳。结论(1)颈椎不稳的“过度代偿”机制可能是多节段高龄颈椎病的发病原因。(2)前路减压手术可以改善高龄颈椎病患者的神经症状,提高生活质量,但手术并发症发生率相对较高。
Objective To investigate clinical features and anterior surgical results of cervical myelopathy in patients more than 70 years of age. Methods Twenty aged patients with cervical myelopathy who underwent anterior decompression with bone graft surgery were reviewed. Neurological function was assessed using a scoring system proposed by the Japanese Orthopaedic Association （JOA score）. The clinical results and complications were compared with the control group which included 31 patients with multisegmental cervical myelopathy and less than 69 years old and underwent the same operation. Results The preoperative mean JOA score was 9.3 （ranged from 3 to 14） and the JOA score at latest follow-up averaged 13.4 （ranged from 8 to 17） in the aged patient group. 68 percent patients had achieved an excellent or good result and the recovery rate was 58%. 71 percent patients had achieved an excellent or good result and the recovery rate was 67% in the control group. No statistical difference was found in the excellent and good result rate or the recovery rate of JOA score between the aged group and the control group （x^2=0.04, P=0.85 ; t=1.12, P=0.138）. The incidence of surgical related complications in the aged group was 35% （7 cases）, which was considerably higher than that in the control group （3 cases, 10%） but without statistical difference （x^2=3.47, P=0.06）. In the preoperative flexion-extension stress lateral radiographs, the incidence of cervical instability was higher in the control group （8 cases, 26%） than that in the aged group（1 case, 5%）. Conclusion 1） Multilevel lesion induced by overcompensation for cervical instability are the probable cause of myelopathy in aged patients. 2） Anterior decompression is beneficial to improve the neurological function and life style in the aged patients with cervical myelopathy, but associated with a high incidence of surgical complications.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2006年第11期734-738,共5页
Chinese Journal of Orthopaedics
关键词
颈椎病
老年人
减压术
外科
Cervical spondylosis
Aged
Decompression, surgical
