目的:分析比较不同颈前路减压术式治疗多节段脊髓型颈椎病术后并发症的差异。方法:回顾性分析2006年1月～2011年8月手术治疗的327例三节段脊髓型颈椎病患者的临床资料,根据手术方式不同分为三组:前路椎间盘切除减压融合术(anterior cerv...目的:分析比较不同颈前路减压术式治疗多节段脊髓型颈椎病术后并发症的差异。方法:回顾性分析2006年1月～2011年8月手术治疗的327例三节段脊髓型颈椎病患者的临床资料,根据手术方式不同分为三组:前路椎间盘切除减压融合术(anterior cervical discectomy with fusion,ACDF)(A组)、前路椎体切除减压融合术(anterior cervical corpectomy with fusion,ACCF)(B组)和ACDF+ACCF"混合式"减压术(C组),其中A组男性69例,女性55例,平均年龄53.48±8.50岁;B组男性51例,女性43例,平均年龄54.36±7.82岁;C组男性61例,女性48例,平均年龄53.68±7.80岁,组间比较无统计学差异。对三种不同手术方式并发症情况进行比较。结果:平均随访时间3.5年(1.5～5年)。共有69例在手术后出现多种并发症,包括植骨未融合11例,其中C组3例(2.75%),B组8例(8.51%),B组植骨不愈合发生率显著高于A组和C组(P<0.05);声音嘶哑12例,其中A组5例(4.03%),B组3例(3.19%),C组4例(3.67%);吞咽困难26例,其中A组11例(8.87%),B组7例(7.45%),C组8例(7.34%);C5神经根麻痹12例,其中A组2例(1.61%),B组5例(5.32%),C组5例(4.59%);脑脊液漏5例,其中A组3例,C组2例;切口感染3例,其中B组2例,C组1例。A组患者并发症发生率为16.94%,B组为26.60%,C组为21.10%,B组患者术后并发症的发生率显著高于其余两组(P<0.05)。结论:多节段脊髓型颈椎病患者手术治疗中,ACDF的并发症发生率最低,ACCF术式应慎用,其并发症的发生率较高。展开更多
目的评估应用3D打印人工椎体和3D打印椎间融合器(Cage)行颈前路椎间盘切除植骨融合术(anterior cervical disectomy and fusion,ACDF)联合颈前路椎体次全切除减压植骨融合术(anterior cervical corpectomy and fusion,ACCF)的临床效果...目的评估应用3D打印人工椎体和3D打印椎间融合器(Cage)行颈前路椎间盘切除植骨融合术(anterior cervical disectomy and fusion,ACDF)联合颈前路椎体次全切除减压植骨融合术(anterior cervical corpectomy and fusion,ACCF)的临床效果。方法回顾分析2018年5月—2019年12月收治并行ACCF联合ACDF治疗的29例多节段脊髓型颈椎病患者临床资料,其中13例采用3D打印人工椎体与3D打印Cage(3D打印组),16例采用钛网笼(titanium mesh cage,TMC)与Cage(TMC组)。两组患者性别、年龄、手术节段、Nurick分级、病程及术前日本骨科协会(JOA)评分、疼痛视觉模拟评分(VAS)、融合节段Cobb角等一般资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中出血量、住院时间、并发症及末次随访时植入物融合情况;术前、术后即刻、术后6个月及末次随访时,采用JOA评分评价神经功能改善情况并计算末次随访时改善率,采用VAS评分评价上肢和颈部疼痛改善情况,测量融合节段Cobb角并计算末次随访时与术后即刻的差值;术后即刻、术后6个月及末次随访时,测量融合节段椎体前缘高度(height of the anterior bord,HAB)和椎体后缘高度(height of the posterior bord,HPB),并计算植入物沉降发生率。结果3D打印组手术时间显著少于TMC组(t=3.336,P=0.002);两组住院时间和术中出血量比较差异均无统计学意义(P>0.05)。两组患者均获随访,随访时间12~19个月,平均16个月。两组术后均未发生明显并发症。重复测量方差分析示,JOA评分、VAS评分与Cobb角各时间点间差异均有统计学意义(P<0.05)。JOA评分中时间与组别有交互作用(F=3.705,P=0.025),随时间延长,3D打印组与TMC组JOA评分升高幅度不同,3D打印组升高幅度更大。VAS评分中时间与组别无交互作用(F=3.038,P=0.065),且两组间各时间点评分差异无统计学意义(F=0.173,P=0.681)。Cobb角的时间与组别有交互作用(F=15.5展开更多
Background：Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy （CSM）.Each posterior technique has its own advantages and disadvantages.In the present study,we co...Background：Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy （CSM）.Each posterior technique has its own advantages and disadvantages.In the present study,we compared the functional and radiological outcomes of expansive hemilaminectomy and laminoplasty with mini titanium plate in the treatment of multilevel CSM.Methods：Forty-four patients with multilevel CSM treated with posterior cervical surgery in Department of Orthopedic Surgery,Beijing Army General Hospital from March 2011 to June 2012 were enrolled in this retrospective study.Patients were divided into two groups by surgical procedure：Laminoplasty （Group L） and hemilaminectomy （Group H）.Perioperative parameters including age,sex,duration of symptoms,opcrative duration,and intraoperative blood loss were recorded and compared.Spinal canal area,calculated using AutoCAD software（Autodesk Inc.,San Rafael,CA,USA）,and neurological improvement,evaluated with Japanese Orthopedic Association score,were also compared.Results：Neurological improvement did not differ significantly between groups.Group H had a significantly shorter operative duration and significantly less blood loss.Mean expansion ratio was significantly greater in Group L （77.83 ± 6.41%） than in Group H （62.72 ± 3.86%） （P 〈 0.01）.Conclusions：Both surgical approaches are safe and effective in treating multilevel CSM.Laminoplasty provides a greater degree of enlargement of the spinal canal,whereas expansive hemilaminectomy has the advantages of shorter operative duration and less intraoperative blood loss.展开更多
文摘目的:分析比较不同颈前路减压术式治疗多节段脊髓型颈椎病术后并发症的差异。方法:回顾性分析2006年1月～2011年8月手术治疗的327例三节段脊髓型颈椎病患者的临床资料,根据手术方式不同分为三组:前路椎间盘切除减压融合术(anterior cervical discectomy with fusion,ACDF)(A组)、前路椎体切除减压融合术(anterior cervical corpectomy with fusion,ACCF)(B组)和ACDF+ACCF"混合式"减压术(C组),其中A组男性69例,女性55例,平均年龄53.48±8.50岁;B组男性51例,女性43例,平均年龄54.36±7.82岁;C组男性61例,女性48例,平均年龄53.68±7.80岁,组间比较无统计学差异。对三种不同手术方式并发症情况进行比较。结果:平均随访时间3.5年(1.5～5年)。共有69例在手术后出现多种并发症,包括植骨未融合11例,其中C组3例(2.75%),B组8例(8.51%),B组植骨不愈合发生率显著高于A组和C组(P<0.05);声音嘶哑12例,其中A组5例(4.03%),B组3例(3.19%),C组4例(3.67%);吞咽困难26例,其中A组11例(8.87%),B组7例(7.45%),C组8例(7.34%);C5神经根麻痹12例,其中A组2例(1.61%),B组5例(5.32%),C组5例(4.59%);脑脊液漏5例,其中A组3例,C组2例;切口感染3例,其中B组2例,C组1例。A组患者并发症发生率为16.94%,B组为26.60%,C组为21.10%,B组患者术后并发症的发生率显著高于其余两组(P<0.05)。结论:多节段脊髓型颈椎病患者手术治疗中,ACDF的并发症发生率最低,ACCF术式应慎用,其并发症的发生率较高。
文摘目的评估应用3D打印人工椎体和3D打印椎间融合器(Cage)行颈前路椎间盘切除植骨融合术(anterior cervical disectomy and fusion,ACDF)联合颈前路椎体次全切除减压植骨融合术(anterior cervical corpectomy and fusion,ACCF)的临床效果。方法回顾分析2018年5月—2019年12月收治并行ACCF联合ACDF治疗的29例多节段脊髓型颈椎病患者临床资料,其中13例采用3D打印人工椎体与3D打印Cage(3D打印组),16例采用钛网笼(titanium mesh cage,TMC)与Cage(TMC组)。两组患者性别、年龄、手术节段、Nurick分级、病程及术前日本骨科协会(JOA)评分、疼痛视觉模拟评分(VAS)、融合节段Cobb角等一般资料比较差异均无统计学意义(P>0.05)。记录并比较两组患者手术时间、术中出血量、住院时间、并发症及末次随访时植入物融合情况;术前、术后即刻、术后6个月及末次随访时,采用JOA评分评价神经功能改善情况并计算末次随访时改善率,采用VAS评分评价上肢和颈部疼痛改善情况,测量融合节段Cobb角并计算末次随访时与术后即刻的差值;术后即刻、术后6个月及末次随访时,测量融合节段椎体前缘高度(height of the anterior bord,HAB)和椎体后缘高度(height of the posterior bord,HPB),并计算植入物沉降发生率。结果3D打印组手术时间显著少于TMC组(t=3.336,P=0.002);两组住院时间和术中出血量比较差异均无统计学意义(P>0.05)。两组患者均获随访,随访时间12~19个月,平均16个月。两组术后均未发生明显并发症。重复测量方差分析示,JOA评分、VAS评分与Cobb角各时间点间差异均有统计学意义(P<0.05)。JOA评分中时间与组别有交互作用(F=3.705,P=0.025),随时间延长,3D打印组与TMC组JOA评分升高幅度不同,3D打印组升高幅度更大。VAS评分中时间与组别无交互作用(F=3.038,P=0.065),且两组间各时间点评分差异无统计学意义(F=0.173,P=0.681)。Cobb角的时间与组别有交互作用(F=15.5
文摘Background：Posterior cervical decompression is an accepted treatment for multilevel cervical spondylotic myelopathy （CSM）.Each posterior technique has its own advantages and disadvantages.In the present study,we compared the functional and radiological outcomes of expansive hemilaminectomy and laminoplasty with mini titanium plate in the treatment of multilevel CSM.Methods：Forty-four patients with multilevel CSM treated with posterior cervical surgery in Department of Orthopedic Surgery,Beijing Army General Hospital from March 2011 to June 2012 were enrolled in this retrospective study.Patients were divided into two groups by surgical procedure：Laminoplasty （Group L） and hemilaminectomy （Group H）.Perioperative parameters including age,sex,duration of symptoms,opcrative duration,and intraoperative blood loss were recorded and compared.Spinal canal area,calculated using AutoCAD software（Autodesk Inc.,San Rafael,CA,USA）,and neurological improvement,evaluated with Japanese Orthopedic Association score,were also compared.Results：Neurological improvement did not differ significantly between groups.Group H had a significantly shorter operative duration and significantly less blood loss.Mean expansion ratio was significantly greater in Group L （77.83 ± 6.41%） than in Group H （62.72 ± 3.86%） （P 〈 0.01）.Conclusions：Both surgical approaches are safe and effective in treating multilevel CSM.Laminoplasty provides a greater degree of enlargement of the spinal canal,whereas expansive hemilaminectomy has the advantages of shorter operative duration and less intraoperative blood loss.
