2008年6月 第29卷 第3期
hamburger
首都医科大学学报
Jour na l of Capita lMedical U niversity
Jun.2008吃苦耐劳英文
Vol.29 No.3maggie smith
硬核是什么意思临床研究
改良单开门椎管成形术治疗脊髓型颈椎病的临床观察
石家庄考研辅导班张庆明 沈惠良 王居勇
(首都医科大学宣武医院骨科)
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【摘要】 目的 评价改良单开门椎管成形术治疗脊髓型颈椎病的疗效。方法 对43例脊髓型颈椎病患者行后正中入路单开门椎管成形术，术中采用刚性门轴固定。用侧块螺钉悬吊固定椎板并保持在开门状态，在颈2脊突上用P DS2Ⅱ可吸收缝线重建伸颈肌群止点，术后3周开始颈部肌肉锻炼。术后检测由日
本骨科协会(JO A)制定的评分标准的变化、开门的幅度、颈椎的总活动度及轴性、根性症状的发生率。结果 术后平均随访22个月(12～36个月)，术前J OA平均为(7.2±3.2)分，术后平均为(14.1±2.1)分，术后开门幅度为(16.7±4.9)mm，颈椎总活动度较术前减小(10.6±4.7)°，术后12个月时轴性症状的发生率为17.83%，根性症状的发生率为7%。按照Odo m术后评定标准，优秀:24例；良好:19例；尚可:3例；差:0例。结论 改良单开门椎管扩大成形术治疗脊髓型颈椎病较传统方法开门幅度大，患者并发症少，效果满意。
【关键词】 颈椎病；椎板成型术；临床效果
【中图分类号】 R681.5+5
C li n i ca l Stud i es of M od i f i ed O pen2door L a m i n opl a sty for
Spondyl ot i c M ye l opa thy
Zhang Q ingm ing,Shen Huiliang,W ang Juyong
(D ep a rt m ent of O rthopeadics,Xuan w u Hostit a l,Ca pita lM edi ca l U ni versity)
al qaida【ABSTRAC T】 Open2door lam ino p last y for s pondyl otic mye l opathy has been documented f
or over30yea rs.This me t hod can deco mpress the v e rtebral canal and i mprove t he nerve func tion satisfac t orily t hrough t he clinical studie s.Ho weve r,radicular and axia l sy mp t o m s including neck m ala i and stiffne ss and other p r oble m s occur f requently af t e r c l o2door ope ra tion.W e ud a modi f i ed open2 door lam i nop l a sty t o trea t the s pondyl otic mye l opathy,and had achi eved satisfac t ory re s ults.O b ject i ve Our pur pos e is t o a s ss the effects of the modified open2door lam in op l a sty for s pondyl otic m yelo pa thy.M e thod s Fro m Oc t ober2003t o Janua ry2006,78pati ents had been treated with open2door lam i nop l a sty and43ca s had been foll o wed2up.The operati on were ca rried out in p rone positi on and unde r gene ra l anesthesia.Titan lag sc rew had been wrung in the la tera l ma ss of C3,C5,C6and C7after the d oor wa s opened,No.10 silk ne sis had been ud t o s ew the Titan lag scre w and the spinous p rocess.The vertebra l pla te was hangwit h la t e ra lm ass scre w to keep the door opening.The end of extens or was repaired by P DS2Ⅱads orbable sut ure on C2proce ssus s p i nosus.Pre2and post2opera tive JOA score s had been ud t o evalua te the cli nical re sults.The axi a l sy mp t o m s and radicular sy mp t o m s were obrv ed t o evalua te the re s ults, using the SPSS11.5s of t w are t o proce ss the da ta.R esults I n the43ca s e s of cervical spondyl otic m yel opa thy,mean foll ow u p wa s22 months(12t o36months).The ave rage p re2OP JOA score was7.2±3.2and post2OP JOA score wa s14.1±2.1;the i mprov em ent ra te was73.1±16.7pe rcent.Sagital dia m ete of vertebr
al canal of pre2opera tion was(11.8±2.2)mm,the average open2door ext ent wa s (16.7±4.9)mm,t he range of moti on of pre2operati on was44.7±5.1degree,the range of moti on of post2opera tion was34.2±4.4 degree,the t ota l range of moti on had reduced17percent after ope ra ti on(the highe st wa s up to71percent according t o the literature),the incidence of axi a l s y mpto m s was17.83pe rcent and the incidence of radicular sy mp t o m s wa s7percent.According t o O d om’s sco ring system.T wenty2four pa tients had excellent result,19go od,3fa ir.C onc l u si on The modified open2d oor lam in op l a sty for s pondyl otic mye l opathy can enlarge the ave rage open2door extent,inc rea s e t he range of motion,reduce the radicular and axial sy mpto m s and neck ma lais e when co mpa red with the trad itiona l me t hod.The modi f i ed open2door la m inopla sty ha s achived satisfactory result.Ho weve r,it problem s still rema in.So m e pa tients fee l neck stiffness after opera tion i n tho.S ome sy mpto m s have not dis appeared co mp letely, e s pecially pa tients with p rol onged cour,e l der age and disabilit y of bladde r or l owe r li mb functi on.
【KEY WO RD S】 ce rvi ca l spondyl osis;la m inop l a sty;cli nical re sult
洗礼是什么意思 y在3年首先报道采用单开门椎管扩大成形术治疗颈椎后纵韧带骨化症、发育性椎管狭窄症、脊髓型颈椎病以来，大量的术后临床观察显示，此种术式在解除脊髓压迫，改善神经功能方面具有较好的效果。但部分患者出现术后长期颈部不适、僵硬、活动受限、疼痛等轴性症状，术后X线显示有不同lawyer是什么意思
Haraba ashi198
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