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学科主题: 外科学
题名:
颈椎人工间盘置换术后手术节段、邻近节段与非邻近节段的椎旁骨化长期进展对比
作者: 曾成
答辩日期: 2016-05-26
导师: 田伟
专业: 外科学
授予单位: 北京大学
授予地点: 北京大学第四临床医学院
学位: 博士
关键词: 颈椎人工间盘置换术 ; 椎旁骨化 ; 异位骨化 ; 分型 ; 邻近节段
其他题名: The comparison of paravertebral ossification progression among operative, adjacent and non-adjacent levels after artificial cervical disc replacement: a 7-year follow-up
分类号: R687.4
摘要:

研究目的:椎旁骨化(PO)是颈椎人工间盘置换术后常会发生的一种现象,关于椎旁骨化的产生原因与影响一直存在争议。由于正常的颈椎节段随着年龄的增长也可能出现新生PO或原有PO的加重,并且不同节段的颈椎PO发生和加重速度可能不同,因此在评价手术是否会影响PO进展时应将其与同节段的正常颈椎进行对比。本研究通过对骨化分级变化情况进行长期随访,评价手术节段、相邻节段及正常节段PO的发生率和生长差异,并进一步探讨CADR对椎旁骨化发生所造成的影响。

研究方法:使用回顾性研究方法,对我院45名(2004年3月-2009年12月)进行单节段Bryan®颈椎人工间盘置换术后的患者进行平均79.6月的随访,对C2/3-C7/T1节段根据改良的基于CT影像的椎旁骨化分级进行分级测量。将各节段分为手术组、邻近节段组及非邻近节段组,并对骨化程度的进展进行组间比较。

结果:末次随访与术前相比,手术节段的L和R区域的高级别骨化明显高于术前,且发生骨化升级的比例显著高于属于非邻近节段的同节段对照组(p<0.05)。末次随访中,虽然手术节段的A和P区域以及邻近节段的所有区域的高级别骨化高于术前,但发生的骨化升级的比例均与属于与非邻近节段的同节段对照组无显著性差异(p>0.05)。

结论:根据长期随访的影像学结果,颈椎间盘置换术不会加重邻近节段的PO发生。术后手术节段的PO发生率较术前明显增高,且影响主要发生在L和R区域(钩椎关节区域),在A和P区域其进展情况与正常节段无明显差异。

英文摘要:

Introduction: Paravertebral ossification (PO) is a vital phenomenon following artificial cervical disc replacement (CADR). Controversy about the cause and seriousness of PO always exists. Because PO could occur in normal cervical spine, and the former PO could grow gradually with age increasing. So if the influence of CADR on the development of PO was going to be assessed, it’s reasonable to compare the operative and adjacent segments with normal segments. Besides, different segments may have different PO growth speed, so each cervical spine segments need to be assessed separately. This study focused on the difference of PO prevalence and progression in operative, adjacent and non-adjacent levels through a long-term follow-up, and discussed the influence of CADR on PO development.

 

Methods: Radiograph data for all patients performed single-level CADR using Bryan disc from a single center were used. Preoperative and 7-year follow-up CT images were collected. Two independent blinded surgeons graded PO based on a revised CT PO grading system from C2/3 to C7/T1 segments in each patient. Each segment was divided into operative, adjacent or non-adjacent level groups. Non-adjacent level group was considered as the normal contrast group. The progression of PO in each group was compared using Chi-square test.

 

Results: A total of 45 patients were included. The average follow-up time was 79.6 months (range 57-108 months). The prevalence of high-level PO in area L and R of operative levels was higher than the normal contrast group in same segments. And the progression of PO in tPOse areas was significantly severer (p<0.05) than non-adjacent levels in comparison of preoperative with the final follow-up. AltPOugh the prevalence of high-level PO in area A and P of operative levels and all areas of adjacent levels was also higher than the normal contrast group in same segments, there was no significant difference (p>0.05) in PO progression.

 

Conclusion: On the results of the 7-year follow-up, CADR had no significant influence on the progression of PO development in adjacent levels. The progression of PO in CADR operative level was concentrated on area L and R, which were basically the areas of Luschka joints.

语种: 中文
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/400002259/124757
Appears in Collections:北京大学第四临床医学院_学位论文

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作者单位: 北京大学第四临床医学院

Recommended Citation:
曾成. 颈椎人工间盘置换术后手术节段、邻近节段与非邻近节段的椎旁骨化长期进展对比[D]. 北京大学第四临床医学院. 北京大学. 2016.
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