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学科主题: 外科学
题名:
颈后路术后轴性疼痛和腰椎Dynesys动态固定的临床研究
作者: 卫沛然
答辩日期: 2014-05-22
导师: 崔彦
专业: 外科学
授予单位: 北京大学
授予地点: 北京大学解放军306医院教学医院
学位: 硕士
关键词: 颈椎 ; 后路椎板减压 ; 轴性症状 ; Dynesys ; 融合 ; 手术 ; 腰椎 ; 退行性疾病
其他题名: The Clinical Study of Axial Pain after Posterior Cervical Laminectomy and the Lumbar Decompression with Dynesys Neutralization System
分类号: R687.3
摘要:

目的  本课题分为2个部分,第一部分:研究C3C6C3C7节段颈椎后路椎板切除减压、融合、侧块螺钉内固定术后临床疗效及轴性疼痛的的差异。第二部分:比较后路减压Dynesys动态固定与后路减压融合内固定治疗单阶段腰椎退行性疾病的近期疗效。

 

方法  第一部分:对我院201105月~201305月期间的48例接受C3C6A组)与C3C7B组)节段后路椎板切除减压、融合、钉棒内固定术的患者进行回顾性分析,随访时间至少1年。对2组患者术前及术后按照日本骨科学会(Japanese Orthopaedic AssociationJOA)脊髓功能评分,颈椎X光片颈椎曲度角度(Cobb’s角)进行评估;分析2组患者术后轴性症状(axial symptomsAS)的发生率,并按照视觉模拟评分(visual analogue scaleVAS)对两组病例术后随访各时段轴性症状(axial symptomsAS)进行比较,并分析其完全缓解所需时间。第二部分:200808月至200912月,对42例接受后路减压Dynesys椎弓根动态稳定系统内同定置入术(A)和传统后路减压融合内固定术(B)的单节段腰椎退变性疾病患者进行回顾性分析,随访时间至少1年。分别观察2组的手术时间、出血量;并按照Oswestry功能障碍指数(Oswestry disability indexODI)评估临床疗效,视觉模拟评分(visual analogue scaleVAS)评估疼痛,以及X光片治疗阶段椎间隙的高度,分别在术前、术后1月、术后3月、术后6月、术后1年及末次随访进行评估。

 

结果  第一部分:2组病例术前及术后JOA评分及颈椎曲度角度(Cobb’s)变化无明显统计学差异(P>0.05);A组轴性疼痛(AS)的发生率为25.0%6/24),B组为41.6%10/24),有统计学差异(P<0.05);A组术后轴性疼痛VAS评分2.8±0.9,B组为5.1±1.1分,有统计学差异(P<0.05);轴性症状缓解时间A组为98.3±10.7天,B组为181.8±9.2天,有统计学差异(P<0.05)。第二部分:A组手术时间及手术出血量明显低于B组(P<0.05);两组术后VAS评分、ODI评分及椎间隙高度均较术前明显改善(P<0.05)。

 

结论  (1) 与传统C3C7颈后路减压手术相比,保留C7棘突、椎板及其后方附着颈后肌群并不影响脊髓功能及颈椎曲度的改变,且可以减轻术后轴性症状(AS)的发生率及程度,并减少缓解所需时间,提高患者生活质量。(2) Dynesys动态固定系统与传统融合手术相比,其临床效果与传统减压融合相当,其出血量及手术时间少,保留腰椎原有活动度,减少临近节段退变,是治疗腰椎退行性疾病的一种有效的非融合性固定方法。
英文摘要:

OBJECTIVE  This study included two parts. Part 1: to evaluate the difference of clinical efficacy and axial pain of the posterior cervical vertebral decompression, fusion and lateral mass screw fixation between C3~C6 and C3~C7 segments. Part 2: to study the clinical efficacy of posterior decompression with dynesys stabilization system on the treatment of one-stage lumbar degenerative disease compared with traditional posterior compression with fusion and fixation.

 

METHODS  Part 1: a total of 48 patients from May 2011 to May 2013 in our hospital, who underwent C3~C6 (group A) and C3~C7 (group B) posterior decompression with laminectomy, fusion and lateral mass screw fixation, were analysed retrospectively, and the follow-up was at least 1 year. We evaluated the Japanese Orthopaedic Association (JOA) score and cervical curvature Angle (cobb’s) of the X-ray before and after operation, and studyed the incidence of postoperative Axial Symptoms (AS), and the axial pain according to visual analogue scale (VAS) score, and also analyzed the time needed for pain relief. Part 2: a total of 42 patients with one-stage lumbar degenerative disease, from August 2008 to December 2009, who underwent posterior decompression with Dynesys stabilization system (group A) and traditional posterior compression with fusion and fixation (group B), were analysed retrospectively, and the follow-up was at least 1 year. We observed the operative time, blood loss, and follow the Oswestry Disability Index (ODI) to evaluate the clinical efficacy, visual analogue scale (VAS) to assess pain, as well as the intervertebral height of the treatment segment in X-ray, respectively. We evaluated the index above before surgery, and 1 months, 3 months, 6 months, 1 year after surgery, respectively, and the final follow-up.

 

RESULTS  Part 1: the changes of JOA score and cervical curvature angle (cobb’s) of the two groups had no significant statistical difference (P>0.05). The incidences of axial pain (AS) in group A and group B were 25.0% (6/24) and 41.6% (10/24) respectively (P<0.05). The VAS socres of postoperative axial pain in group A and group B were 2.8±0.9 and 5.1±1.1 respectively (P< 0.05). The time needed for axial pain relief of group A and group B were 98.3±10.7d and 181.8±9.2d respectively (P< 0.05). Part 2: the operative time and blood loss of group A were significantly lower than those of group B (P<0.05), And both of them got significantly improved after operation (P<0.05).

 

CONCLUSION  (1) Compared with traditional posterior cervical decompression surgery, keeping the spinous process of C7, vertebral plate and rear adherent neck muscles did not influence the spinal cord function and the change of cervical curvature, could reduce the incidence and degree of postoperative axial symptoms, and also the time needed for pain relief, thus, improve the life quality of the patients. (2) Compared with the traditional fusion surgery, the blood loss and the operative time of Dynesys dynamic stabilization system were much less. The clinical efficacy was same as that of traditional decompression and fusion, and it retained the mobility of lumbar, reduced the rate of adjacent segment degeneration(ASD). The study showed that Dynesys stabilization system was an effective non-fusion fixation treatment in lumbar degenerative disease.
语种: 中文
出处: http://xuewei.bjmu.edu.cn/simpsearch.action?keyword=颈后路术后轴性疼痛和腰椎Dynesys动态固定的临床研究&dbid=72
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/105443
Appears in Collections:北京大学解放军306医院教学医院_学位论文

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作者单位: 北京大学解放军306医院教学医院

Recommended Citation:
卫沛然. 颈后路术后轴性疼痛和腰椎Dynesys动态固定的临床研究[D]. 北京大学解放军306医院教学医院. 北京大学. 2014.
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