摘要
目的:探究和评价前路椎间盘切除聚醚醚酮(polytheretherketone,PEEK)椎间融合器辅助的椎体间植骨融合术(anterior cervical discectomy and fusion,ACDF)治疗伴有交感神经症状颈椎病的临床效果。方法:回顾性分析39例伴有交感神经症状的颈椎病并接受前路椎间盘切除加PEEK椎间融合器辅助的植骨融合术患者的临床资料,融合率评估采用X线片及动力位X线片,必要时采用CT重建判定其融合率,采用20分评分法分别在术前、术后2个月及末次随访时对头晕等交感神经症状进行评分,计算末次随访时的改善率及临床效果满意率,并进行统计学分析。结果:所有患者均经过不少于1年随访,随访时间为12~36个月,平均15.6个月。36例完全融合,2例术后半年延迟愈合,1例假关节形成,但无临床症状,融合率为97%,平均融合时间为3.6个月。术后交感神经症状都有不同程度改善,术前交感神经症状评分为8.4±1.0,术后2个月评分为2.2±0.3,末次随访评分为2.4±0.3,差异有统计学意义(F=176.57,P<0.001)。改善率为优22例,良15例,可1例,差1例,临床效果满意率为95%。1例患者发生脑脊液漏,1周后恢复;2例患者出现轻度吞咽不适,1个月后恢复;1例患者由于引流不畅出现皮下血肿,经血肿清除后恢复。结论:前路ACDF是治疗伴有交感神经症状的颈椎病的较为安全有效的手术方法。
Objective:To investigate the clinical effectiveness of polytheretherketone(PEEK)cages assisted anterior cervical discetomy and fusion(ACDF)to treat cervical spondylosis with sympathetic symptoms.Methods:Retrospective analysis was undertaken for 39 patients who were diagnosed as cervical spondylosis with sympathetic symptoms and underwent ACDF with PEEK cages.Radiographs obtained before surgery,after surgery,and at the final follow-up were assessed for quality of fusion.The following criteria were used for assessing radiographic success of fusion:(1)endplate obliterated with no lucent lines;(2)obliteration of disc space by bony trabeculae;(3)less than 2°of intervertebral motion or 2 mm of motion between the spinous processes at the operated segment on flexion-extension lateral radiographs.The sympathetic symptoms including vertigo,headache,tinnitus,nausea and vomiting,heart throb,hypomnesia and gastroenterological discomfort were scored by 20-point system preoperatively,2 months postoperatively and at the final follow-up.The recovery rate and clinical satisfaction rate were also evaluated.Surgical complications were also assessed.Results:They were followed up for at least one year.The mean follow-up was 15.6 months.Radiographs of the cervical spine at the last follow-up revealed a solid fusion with no signs of a pseudoarthrosis in 36 cases.In two patients delayed union and bony fusion were achieved at the end of 9 and 11 months.Pseudoarthosis was found in 1 case but the patient had no symptoms.The score of sympathetic symptoms before surgery,2 months after surgery and at the final follow-up were 8.4±1.0,2.2±0.3,and 2.4±0.3,respectively.There were 22 excellent cases,15 good cases,1 fair case and 1 bad case in terms of RR.Good to excellent results were attained in 95%of theses patients.The sympathetic symptoms improved in all the patients and the score was significantly improved after surgery.There was one patient who had cerebral spinal fluid leakage but he recovered one week after surgery.Two patients felt a m
作者
刘洪
越雷
陈顺伦
胡博
李淳德
邑晓东
李宏
卢海霖
王宇
于峥嵘
孙浩林
王诗军
赵耀
漆龙涛
王瑞
LIU Hong;YUE Lei;CHEN Shun-lun;HU Bo;LI Chun-de;YI Xiao-dong;LI Hong;LU Hai-lin;WANG Yu;YU Zheng-rong;SUN Hao-lin;WANG Shi-jun;ZHAO Yao;QI Long-tao;WANG Rui(Department of Orthopaedic Surgery,Peking University First Hospital,Beijing 100034,China)
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2018年第2期347-351,共5页
Journal of Peking University:Health Sciences
关键词
前路
椎间融合
治疗
交感神经症状
颈椎病
头晕
Anterior procedure
Cervical discectomy and fusion
Treatment
Cervical spondylosis
Sympathetic symptoms
Vertigo
