本文選題：頸椎后凸畸形 + 前路　； 參考：《廣西醫(yī)科大學(xué)》2015年碩士論文

【摘要】：目的:分析前路與后路矯形手術(shù)治療頸椎后凸畸形的臨床療效,為臨床選擇手術(shù)入路提供參考。方法:回顧性分析2008年1月-2013年12月,廣西醫(yī)科大學(xué)第一附屬醫(yī)院共收治61例頸椎反曲畸形的患者。男性患者37例,女性患者24例,年齡在2~78歲之間,平均(43.7±15.0)歲。按引起后凸畸形的病因分為:醫(yī)源性(主要為頸椎板切除未做內(nèi)固定的患者)后凸29例,外傷性后凸16例,退變性后凸12例,疾病性后凸畸形4例。術(shù)前JOA評分5~12分,均值為(8.70±1.67)分;術(shù)前反曲Cob b角在9.3°~28.2°之間,均值為(14.4±3.3)°,行頸椎后凸畸形矯形手術(shù)。其中39例⺌Cobb角在9.3°~19.5°之間,平均(14.1±2.7)°,其中:醫(yī)源性患者涉及3個及以內(nèi)節(jié)段;外傷性患者為損傷前柱或部分中柱且后柱完好;退變性患者主要為涉及前柱、中柱及椎間盤部分伴有后縱韌帶骨化;疾病性患者畸形涉及少于3個節(jié)段。以上所有病例無頸椎后柱骨性融合,術(shù)前JOA評分(8.54±1.70)分⺗行前路手術(shù);22例⺌Cobb角9.6°~28.2°,平均(15.1±4.3)°,其中:醫(yī)源性患者涉及3個以上節(jié)段;外傷性患者為后柱或部分伴中柱受損但無骨性移位的病例;退變性患者為后柱出現(xiàn)骨性融合;疾病性患者為涉及三個以上椎體的病例。以上所有病例均無頸椎前柱骨性融合,術(shù)前平均JOA評分(9.00±1.63)分⺗行后路手術(shù)。記錄并分析患者手術(shù)時間、手術(shù)中出血量、住院天數(shù),術(shù)前、術(shù)后及末次隨訪的JOA評分、Cobb角度數(shù)的變化。結(jié)果:39例前路手術(shù)的患者的平均手術(shù)時間為(111.6±38.4)min,術(shù)中平均失血量為(335.6±308.3)ml,平均住院時間(12.6±6.0)天;術(shù)后Cobb角為(5.1±1.2)°與術(shù)前比較有明顯減小,術(shù)后即刻反曲畸形矯正率平均(63.0±9.4)%;12~31個月的隨訪,平均約21個月,最后一次隨訪時Cobb角平均為(6.5±1.3)°與術(shù)前比較有較明顯減小,平均矯正丟失率達(16.2±7.0)%;術(shù)后一周內(nèi)JOA評分為(11.82±1.55)分,最后一次隨訪時JOA評分為(15.53±1.41)分,與術(shù)前比較均有明顯改善,末次隨訪改善率為(83.8±13.0)%。22例后路手術(shù)患者的平均手術(shù)時間為(146.5±60.3)min,手術(shù)中平均出血達(661.4±330.2)ml,平均住院天數(shù)為(17.3±6.4)天;術(shù)后Cobb角為(9.1±2.6)°與術(shù)前比較有明顯減小,術(shù)后即刻反曲畸形矯正率平均(39.2±9.1)%;12-54個月的隨訪,平均隨訪約25個月,末次隨訪時Cobb角為(10.0±3.4)°與術(shù)前比較有較明顯減小,其矯正丟失率為(13.3±27.7)%;術(shù)后一周內(nèi)JOA評分為(11.31±1.04)分,最后一次隨訪JOA評分為(15.04±1.76)分,與術(shù)前比較均有明顯改善,末次隨訪改善率為(76.3±20.1)%。結(jié)論:前入路和后入路矯形手術(shù)方式均是。前入路較后入路矯正頸椎后凸畸形術(shù)具有手術(shù)時間短、住院時間少,出血量少等優(yōu)點。
[Abstract]:Objective: to analyze the clinical effect of anterior and posterior orthopedic surgery in the treatment of cervical kyphosis. Methods: from January 2008 to December 2013, 61 patients with cervical reflexive deformity were treated in the first affiliated Hospital of Guangxi Medical University. There were 37 males and 24 females, aged between 2 and 78 years, with an average age of 43.7 鹵15.0 years. According to the causes of kyphosis, 29 cases of iatrogenic kyphosis, 16 cases of traumatic kyphosis, 12 cases of degenerative kyphosis and 4 cases of diseased kyphosis were divided into three groups: iatrogenic kyphosis (29 cases), traumatic kyphosis (16 cases) and degenerative kyphosis (4 cases). The preoperative JOA score ranged from 5 to 12 with an average of 8.70 鹵1.67, and the preoperative Cob b angle was between 9.3 擄and 28.2 擄, with a mean of 14.4 鹵3.3 擄. Among them, 39 cases had Cobb angle between 9.3 擄and 19.5 擄, with an average of 14.1 鹵2.7 擄. Among them, iatrogenic patients involved 3 or more internal segments, traumatic patients were injured anterior column or part of middle column and posterior column was intact, degenerative patients mainly involved anterior column. Medial column and intervertebral disc with ossification of posterior longitudinal ligament; deformities of diseased patients involved less than 3 segments. There was no posterior column bone fusion in all of the above cases. The preoperative JOA score was 8.54 鹵1.70? 22 cases underwent anterior approach with Cobb angle 9.6 擄鹵28.2 擄(mean 15.1 鹵4.3 擄), in which iatrogenic patients involved more than 3 segments, traumatic patients with posterior column or part with middle column damage but no bone displacement, degenerative patients with posterior column bone fusion. Diseased patients are cases involving more than three vertebrae. There was no anterior column bony fusion in all of the above cases. The mean preoperative JOA score was 9.00 鹵1.63? Perform posterior surgery. The time of operation, the amount of blood lost during operation, the days of hospitalization, the changes of JOA score and Cobb angle of preoperative, postoperative and last follow-up were recorded and analyzed. Results the mean operative time, blood loss and hospital stay were 111.6 鹵38.4 min, 335.6 鹵308.3 ml and 12.6 鹵6.0 days respectively, and the postoperative Cobb angle of 5.1 鹵1.2 擄decreased significantly compared with those before operation. The mean Cobb angle at the last follow-up was 6.5 鹵1.3 擄, and the average corrected loss rate was 16.2 鹵7.0 擄, the JOA score was 11.82 鹵1.55 in the first week after operation, and the JOA score was 15.53 鹵1.41 at the last follow-up. The average operative time was 146.5 鹵60.3 min, the mean bleeding was 661.4 鹵330.2ml, the average hospital stay was 17.3 鹵6.4 days, and the postoperative Cobb angle was 9.1 鹵2.6) 擄. The average correction rate was 39.2 鹵9.1% for 12-54 months, and the average follow-up was 25 months. The Cobb angle was 10.0 鹵3.4 擄at the last follow-up, and the corrected loss rate was 13.3 鹵27.7%, and the JOA score was 11.31 鹵1.04) in the first week after operation. The JOA score of the last follow-up was 15.04 鹵1.76, and the improvement rate was 76.3 鹵20.1%. Conclusion: both anterior approach and posterior approach are orthopedic. The anterior approach has the advantages of shorter operation time, less hospital stay and less bleeding than posterior approach for correction of cervical kyphosis.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R687.3

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