后路减压侧块内固定治疗多节段颈椎间盘突出症的疗效观察

Effect of posterior decompression and lateral mass screws fi xation on cervical disc herniation

  • 摘要: 目的 探讨后路椎板减压、侧块钉棒内固定治疗多节段颈椎间盘突出症的临床效果。 方法 回顾性分析我科2015年1月- 2017年12月收治的31例多节段颈椎间盘突出症患者的临床资料。所有患者均行经颈后路全椎板切除侧块钉棒内固定手术。术前、术后采用日本骨科协会(Japanese Orthopaedic Association,JOA)评分判定神经功能,以颈椎功能残障指数量表(neck disability index,NDI)评价颈肩轴性痛程度,颈椎磁共振测量硬膜囊前后径和脊髓后移距离,联合使用Borden法和C2 ~ C7 Cobb角测量法评价颈椎曲度变化量。 结果 31例术后随访8 ~ 20个月,平均随访为12个月。男23例、女8例,平均年龄46(32 ~ 64)岁,术前平均JOA评分为6.2分,术后为10.3分,差异有统计学意义(P=0.038);术前平均NDI评分为5.2分,术后为19.3分,差异有统计学意义(P=0.029);颈椎MRI最狭窄处直径术后较术前增加69.2%、颈脊髓平均向后漂移4.6 mm,差异均有统计学意义(P=0.031)。 结论 此手术方式可减轻颈段脊髓压迫症状,预防脊髓缺血变性,恢复神经功能和颈椎生理曲度,缓解颈椎轴性疼痛。

     

    Abstract: Objective To explore the clinical effect of posterior laminectomy and lateral mass screw-rod system internal fi xation in the treatment of cervical disc herniation. Methods A retrospective analysis of clinical data about 31 patients with cervical disc herniation from January 2015 to December 2017 in our department was performed. All patients had undergone posterior laminectomy and mass screw-rod system internal fi xation. The Japanese Orthopaedic Association Scores (JOA) and neck disability index (NDI)were applied to evaluate the neurological function and neck/shoulder axial pain before and after surgery respectively. The dural sac and degree of spinal cord shifting were measured by MRI, and the cervical curvature change was evaluated by the combination of Borden method and C2-C7 Cobb angle measurement. Results Totally 31 patients were followed up for 8-20 months, and the average follow-up time was 12 months. Among them, there were 23 males and 8 females with an average age of 46 years old (range, 32-64). There were significant differences between post- and pre-operative JOA score (10.3 vs 6.2, P=0.038) and NDI score (19.3 vs 5.2, P=0.029). The anteroposterior diameter at the level of maximum compression of the dural sac in MRI was 69.2%, which was higher than that before operation, and the mean cervical spinal cord posterior shift was (4.6±1.2) mm with significant differences when compared with before operation (P=0.031). Conclusion Posterior decompression plus lateral mass screws fi xation can relieve symptoms of cervical spinal cord compression, prevent spinal cord ischemic degeneration, restore cervical nerve function and cervical physiological curvature, and relieve cervical axial pain.

     

/

返回文章
返回