【作者】 夏晴；

【导师】 董健； 李熙雷；

【作者基本信息】 复旦大学 ， 外科学， 2009， 硕士

【摘要】 【目的】通过自锁定聚醚醚酮椎间融合器和自体髂骨块植骨治疗颈椎病的临床对照研究,比较手术时间、手术前后JOA评分改善率、颈椎生理弧度的纠正及椎间隙高度的恢复情况,评价两种融合方法的应用效果。【方法】2005年6月～2008年6月,采用颈前路聚醚醚酮椎间融合器和自体髂骨块植骨联合钢板内固定治疗颈椎病共102例。椎间融合器组(A组)患者56例,106个节段;自体髂骨联合钢板内固定组(B组)患者46例,共89个节段。两组患者术前、术后、术后3月、6月、12月均行正侧位X线片,术后3～12月行CT矢状位二维重建,根据患者临床症状及体征确定术前术后JOA评分,根据枢椎齿突后缘至C7椎体后缘连线与C4椎体后缘中点的垂直距离描述颈椎生理弧度,根据病变椎间隙的上下椎体前、中、后缘高度的平均值确定椎间隙高度。比较两组手术时间、患者术前术后JOA评分、颈椎生理弧度、椎间隙高度等指标。【结果】术后随访10～30个月,A组手术时间明显少于B组。在9个月随访时,AB两组病变椎间隙均取得完全植骨融合。AB两组术后JOA评分均较术前有明显差别,两组JOA评分改善率没有统计学差别;AB两组术后颈椎生理弧度及椎间隙高度较术前有明显改善,改善程度在AB两组间没有统计学差别。【结论】应用颈前路自锁定椎间融合器能有效地恢复颈椎的生理弧度及椎间隙高度,可以获得满意的融合率,手术操作简便,组织损伤少,是目前治疗颈椎病较好的融合方法之一。更多还原

【Abstract】 Objectives:To assess the effects of the two cervical spinal fusion by comparing the operation time,the improvement rate of JOA scores,the correction of cervical physiological curvature and the restoring of intervertebral height in a control study on self-locking polyetheretherketone(PEEK)cage and autogenous iliac crest graft combined with internal plate fixation through anterior approach for the treatment of cervical spondylosis.Methods:A total of 102 patients underwent interbody fusion with PEEK cage or autogenous iliac crest graft combined with internal plate fixation from Jun 2005 to Jun 2008 were reviewed retrospectively.Patients in Group A(56 patients,106 segments) had anterior interbody fusion with PEEK cage,and patients in Group B(46 patients, 89 segments)had anterior interbody fusion with autogenous iliac crest graft combined with internal plate fixation.All patients in the two groups took the anteroposterior and lateral cervical X-ray examinations before operation,after operation and at the postoperative 3rd,6th and 12th month,and underwent two-dimensional sagittal CT reconstruction in 3～12 months after operation.Preoperative and postoperative JOA scores were evaluated based on clinical symptoms and signs,cervical physiological curvature was described based on the vertical distance between the midpoint of posterior margin of C4 and the straight line from the posterior margin of the dens to the posterior margin of C7 vertebral body and the intervertebral height was determined as the average value of anterior,middle and posterior intervertebral height of adjacent vertebra.Datas such as operation time,preoperative and postoperative JOA scores,cervical physiological curvature,and the intervertebral height were compared.Results:All patients were followed up for 10～30 months.The operation time in Group A was much less than that in Group B.At the 9th month of follow-up,patients in both Group A and Group B all had complete interbody fusion.Postoperative JOA scores in both Group A and Group B were more than the preoperative ones with significant differences,and the improvement rate of JOA scores had no statistical differences between group A and group B.Postoperative cervical physiological curvature and the intervertebral height in both Group A and Group B were better than the preoperative ones with statistical significances,and the degree of improvement had no statistical differences between Group A and Group B.Conclusions:Anterior polyetheretherketone(PEEK)cage can effectively restore the cervical physiological curvature and the intervertebral height,and it can achieve a satifactory fusion rate.It is a simple operation,and had minor soft tissue injury.At present,this is a good fusion operation in the treatment of cervical spondylosis.更多还原