经皮脊柱内镜下手术治疗腰5-骶1椎间盘突出症

目的 探讨经皮脊柱内镜下手术治疗腰5-骶1椎间盘突出症的方法及效果。方法 回顾性分析2013年3月至2016年1月经皮脊柱内镜下手术治疗的38例腰5-骶1腰椎间盘突出症的临床资料,采用经椎间孔入路26例,经椎板间入路12例。手术前后采用疼痛视觉模拟量表（VAS）评分、MacNab量表评分、KPS评分和日本骨科协会（JOA）评分评估疗效。随访时间大于6个月。结果 38例中,34例（89.5%）疗效优良。术后VAS评分[（1.0±1.5）分]较术前[（7.9±1.1）分]明显降低（P<0.05）。术后腰椎JOA评分[（21±5.7）分]较术前[（7.4±4.6）分]明显提高（P<0.05）。经椎间孔入路和经椎板间入路的手术疗效无明显差异。结论 经皮脊柱内镜下选择椎间孔入路或椎板间入路均可有效、安全并且微创地治疗腰5-骶1腰椎间盘突出症。     

不同手术方式治疗多节段脊髓型颈椎病的疗效观察

目的探讨不同手术方式对多节段脊髓型颈椎病的治疗效果。方法选取因多节段脊髓型颈椎病在我院行首次颈椎后路手术的84例患者为研究对象。根据手术方式的不同分为3组,A组行颈椎后路单开门椎管扩大椎板成形术,B组行颈椎后路全椎板切除术,C组行颈椎后路全椎板切除侧块螺钉内固定术,比较3种手术方式患者术前、术后JOA评分、VAS评分,分析颈椎后路3种手术方式对多节段脊髓型颈椎病的临床疗效。结果 3组术后3个月、末次随访JOA评分与术前相比,差异均有统计学意义(P0.05);术后3个月神经功能改善组间比较,差异均无统计学意义(P0.05);末次随访神经功能改善组间比较,差异均有统计学意义(P0.05)。3组术后3个月、末次随访VAS评分与术前相比,差异均有统计学意义(P0.05);术后3个月VAS评分组间相比,差异均无统计学意义(P0.05);末次随访VAS评分组间相比,差异均有统计学意义(P0.05)。结论颈椎后路单开门椎管扩大椎板成形术、颈椎后路全椎板切除术、颈椎后路全椎板切除侧块螺钉内固定术等3种术式治疗多节段脊髓型颈椎病短期预后较好,但颈椎后路全椎板切除侧块螺钉内固定术在远期改善患者神经功能、降低颈肩痛的发生风险方面具有显著优势,是颈椎后路治疗多节段脊髓型颈椎病理想的手术方式。     

显微镜下ACDF与常规ACDF治疗脊髓型颈椎病的对比分析

目的 比较显微镜下颈椎前路椎间盘切除融合术（ACDF）与常规ACDF治疗脊髓型颈椎病（CSM）的疗效。方法 回顾性分析2016年3月至2017年5月ACDF治疗的57例CSM的临床资料，其中采用显微镜下ACDF治疗28例（显微组），常规ACDF治疗29例（常规组）。结果 显微组术中出血量、术后引流量均明显少于常规组（P<0.05）。两组手术时间、住院时间、术后JOA评分、NDI评分、VAS评分均无明显差别（P>0.05）。结论 显微镜下ACDF和常规ACDF治疗脊髓型颈椎病均疗效满意，显微镜下ACDF具有出血量少、术后引流量少、视野清晰等优点。     

旁正中椎板切开复位技术在腰段椎管内肿瘤切除术中的应 用

目的 探讨旁正中椎板切开复位技术在脊柱稳定性未破坏的腰段椎管内肿瘤切除术中的应用效果。方法 回顾性分析2016年6月~2019年4月显微手术治疗的30例腰段椎管内肿瘤的临床资料，术中应用旁正中椎板切开复位技术。结果 术后均未发生切口感染、脑脊液漏和顽固性腰痛等。术后病理检查显示，神经鞘瘤24例，室管膜瘤6例。术后随访6个月，术后日本骨科协会（JOA）评分和视觉模拟量表评分均明显改善（P<0.05）。术后6个月，JOA评分改善率为（69.30±17.03）%，显效21例，有效9例。结论 对于脊柱稳定性未破坏的腰段椎管内肿瘤切除术，旁正中椎板切开复位技术效果良好。     

单侧半椎板入路手术治疗椎管内髓外硬膜下肿瘤的疗效分析

目的 探讨单侧半椎板入路手术切除椎管内髓外硬膜下肿瘤的疗效。方法 回顾性分析2017年1月至2021年6月经单侧半椎板入路手术切除的22例椎管内髓外硬膜下肿瘤的临床资料。结果 肿瘤位于颈段4例,胸段11例,腰段7例。22例肿瘤均全切除,术后病理示神经鞘瘤15例、脊膜瘤6例、蛛网膜囊肿1例。术后随访6个月～5年,与术前相比,出院时美国脊髓损伤协会（ASIA）分级明显改善（P<0.05）,疼痛视觉模拟量表（VAS）评分明显降低（P<0.05）;与出院时相比,末次随访ASIA分级进一步改善（P<0.05）,VAS评分进一步降低（P<0.05）。随访期间,未出现新的神经功能缺损;MRI检查均未见肿瘤复发,脊柱X线检查未见脊柱畸形。结论 单侧半椎板入路手术切除椎管内髓外硬膜下肿瘤创伤小,对脊柱稳定性影响小,疗效良好。     

Ⅰ期前后联合入路手术治疗颈椎骨折合并颈髓损伤

目的 比较Ⅰ期手术与分期手术治疗颈椎骨折合并颈髓损伤的疗效差异。方法 2010年6月至2014年10月收治颈椎骨折合并颈髓损伤26例,其中16例采用Ⅰ期前后联合入路手术,10例采用分期手术（Ⅰ期后路减压+内固定手术、Ⅱ期前路椎间盘摘除+椎体固定术）,以Frankel分级和日本骨科协会（JOA）评分评估脊髓功能,并计算改善率=（术后JOA评分-术前JOA评分）/（17-术前JOA评分）×100%。结果 两组手术前后Frankel分级均无统计学差异（P>0.05）。两组术前JOA评分无统计学差异（P>0.05）,两组术后2 d、3个月、6个月JOA评分较术前均明显增高（P<0.05）,ⅰ期手术组增高更明显（>P<0.05）;术后3、6个月,ⅰ期手术组改善率均明显高于分期手术组（>P<0.05）。>结论 Ⅰ期前后联合入路手术治疗颈椎骨折合并颈髓损伤,能及时、彻底地解除对脊髓压迫,恢复颈椎稳定性,缩短疗程,近期、远期疗效明显,是安全有效的手术方式。     

半椎板-小关节突切除术后颈椎稳定性的研究

目的 探讨经半椎板-小关节突切除椎管内外哑铃形肿瘤后对颈椎稳定性的影响及相关因素。方法 回顾性分析经后路患侧半椎板-小关节突切除入路治疗的25例颈椎哑铃形肿瘤患者（研究组）的资料。选取同期经半椎板椎管内肿瘤切除病例30例为对照组。对手术前后的临床及医学影像进行复习,评价患者疗效及脊柱生物力学的变化。结果 本组25例哑铃形肿瘤、对照组30例椎管内肿瘤均获全切,患者近期疗效满意。随访7个月-10年,平均4.28年,颈椎总运动度两组均无变化;颈椎曲度恶化发生率研究组为8％,对照组为10％(P＞0.05);颈椎不稳定性发生率研究组为4％,对照组为3％（P＞0.05）。远期疗效两组间差异无统计学意义(P＞0.05)。结论 良性颈椎管内外哑铃形肿瘤经后路半椎板-小关节突入路切除,手术对颈椎运动度、生理曲度影响小,手术后不稳定发生率低。     

显微镜下经管道与开放式腰椎间盘摘除术综合疗效对比分析

目的 探讨显微镜下经管道与开放式腰椎间盘摘除术的综合疗效。方法 回顾性分析2014年6月至2016年6月手术治疗的165例腰椎间盘突出症的临床资料，其中96例行显微镜下经管道腰椎间盘摘除术（观察组），60例行开放式腰椎间盘切除术（对照组）。所有病人术后平均随访（12.7±1.1）个月。采用视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）评估疗效。末次随访采用Macnab标准评定术后功能。结果 与对照组相比，观察组手术时间明显延长，住院时间明显缩短（P<0.05），术中出血量明显减少（P<0.05）。观察组术后并发症发生率（4.1%）与对照组（3.0%）无统计学差异（P>0.05）。两组术前VAS评分、ODI均无统计学差异（P>0.05）；两组术后1周、3个月、12个月VAS评分、ODI均较术前均明显降低（P<0.05）；而且，术后1周、3个月，观察组VAS评分均显著低于对照组（P<0.05）。末次随访两组Macnab功能无统计学差异（P>0.05）。结论 与开放式腰椎间盘切除术比，显微镜下经管道腰椎间盘摘除术治疗腰椎间盘突出症康复快、住院时间短。     

椎管内病变全椎板切除术中椎板棘突还纳对脊柱稳定性的影响

目的 探讨椎管内病变全椎板切除术中椎板棘突还纳对脊柱稳定性的影响。方法 回顾性分析2011年1月至2013年6月手术治疗并回访成功的28例椎管内病变的临床资料,术中还纳椎板棘突9例（观察组）,未还纳19例（对照组）。根据术后MRI表现判定脊柱稳定性。结果 观察组术后随访1~6个月3例,6~12个月3例,>12个月3例;对照组术后随访1~6个月7例,6~12个月8例,>12个月4例。观察组术后脊柱失稳率（0%）明显低于对照组（84.2%,16/19;P<0.05）。结论 椎管内病变全椎板切除术中椎板棘突还纳可以明显提高脊柱稳定性。     

外视镜下行颈椎前路椎间盘切除融合术治疗颈椎病的疗效

目的探讨外视镜下行颈椎前路椎间盘切除融合术(ACDF)治疗颈椎病的有效性和安全性。方法回顾性分析2017年3月至2019年3月复旦大学附属中山医院神经外科收治的15例颈椎病患者的临床资料,所有患者均行外视镜下ACDF。术后行临床随访和影像学随访,以患者的Odom评分和日本骨科协会(JOA)颈椎评分评估手术疗效。结果15例患者(19个节段)的手术用时为(100±6)min(80~160 min),术中出血量为(75±10)ml(40~150 ml)。椎间盘融合比例为19/19。1例患者术后发生一过性声音嘶哑,无一例死亡。所有患者均获随访,随访时间为(11.3±1.7)个月(3~27个月)。术后3个月的Odom评分结果表明,非常满意12例,满意3例。15例患者术后3个月的JOA颈椎评分为(15.8±0.2)分,高于术前的(13.3±0.4)分(t=5.8,P<0.01)。所有患者术后的症状均明显缓解,脊髓功能明显改善。结论外视镜下行ACDF治疗颈椎病的效果良好,且并发症少,值得在临床上推广应用。     

3D外视镜辅助前路颈椎间盘切除融合术治疗脊髓型颈椎病的疗效

目的 探讨3D外视镜辅助前路颈椎间盘切除融合术(ACDF)治疗脊髓型颈椎病的效果.方法 回顾性分析2019年1～6月3D外视镜辅助ACDF治疗的15例脊髓型颈椎病的临床资料.术后随访12～16个月,平均(14.40±1.45)个月,采用日本骨科协会(JOA)评分评估神经功能.结果 所有病人均在3D外视镜辅助下顺利完成手...     

Comparison of 2-year follow-up results of the hybrid surgery using Mobi-C combined with ROI-C and anterior cervical discectomy and fusion for the treatment of contiguous two-level cervical degenerative disc diseases

Although the Mobi-C artificial disc and the ROI-C cervical cage have been widely used in the treatment of cervical degenerative disc diseases (CDDD), few reports addressed the features of combined application of both devices. This study is aimed at comparing the clinical and radiological outcomes of treating contiguous two-level CDDD using Mobi-C and ROI-C combined in a hybrid surgery (HS) with anterior cervical discectomy and fusion (ACDF) using ROI-C. We reviewed ninety-one patients who underwent HS (n = 48) or ACDF (n = 43) surgery for symptomatic contiguous two-level CDDD. >2 years’ clinical and radiological outcomes were reviewed and evaluated retrospectively. At the last follow-up, significant improvement in the mean VAS, JOA, and NDI scores was found both in the HS and ACDF groups (p < 0.05), while the differences between groups were not significant (p > 0.05). The global range of motion (ROM) in the HS group was significantly larger than that in the ACDF group (p < 0.05). The local lordosis improved significantly after surgery in all patients (p < 0.05). Bone resorption and heterotopic ossification (HO) were found after surgery. The result showed that, for the selected patients, HS may provide an alternative approach for the treatment of contiguous two-level CDDD. HS also offers the benefit of both greater global ROM and greater ROM at the Mobi-C index level. Some degree of bone resorption may be an integral component in the early stage of bony fusion in the cage index level. Further studies and long-term follow-up are still needed.     

Clinical and radiologic comparison of dynamic cervical implant arthroplasty versus anterior cervical discectomy and fusion for the treatment of cervical degenerative disc disease

This study compared the clinical and radiological outcomes of dynamic cervical implant (DCI; Scient’x, Villers-Bretonneux, France) arthroplasty versus anterior cervical discectomy and fusion (ACDF) for the treatment of cervical degenerative disc disease. This prospective cohort study enrolled patients with single-level cervical degenerative disc disease who underwent DCI arthroplasty or ACDF between September 2009 and June 2011. Patients were followed up for more than 2 years. Clinical evaluation included the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), Neck Disability Index (NDI), Japan Orthopedic Association (JOA) score, and visual analog scale (VAS) scores for neck and arm pain. Radiological assessments included segmental range of motion (ROM), overall ROM (C2–C7), disc height (DHI), and changes in adjacent disc spaces. The VAS, SF-36, JOA, and NDI scores improved significantly after surgery in both the DCI and ACDF groups. The VAS, JOA, and SF-36 scores were not significantly different between the DCI and ACDF groups at the final follow-up. The segmental ROM at the treated level and overall ROM increased significantly after surgery in the DCI group, but the ROM in the adjacent cephalad and caudal segments did not change significantly. The mean DHI at the treated level was significantly restored after surgery in both groups. Five patients (12.8%) in the DCI group showed new signs of adjacent segment degeneration. These results indicate that DCI is an effective, reliable, and safe procedure for the treatment of cervical degenerative disc disease. However, there is no definitive evidence that DCI arthroplasty has better intermediate-term results than ACDF.     

直接后路加压器械撑开复位枕颈融合术治疗颅底凹陷症合并寰枢椎脱位的疗效

目的 探讨直接后路加压器械撑开复位枕颈融合术治疗颅底凹陷症伴寰枢椎脱位的安全性和有效性。方法 回顾性分析2017年1月至2018年1月采用枕颈融合术治疗的19例颅底凹陷症伴寰枢椎脱位的临床资料。采用日本骨科协会（JOA）评分和Ranawat分级评估神经功能恢复情况，测量齿状突至钱氏线（CL）、颅底斜坡切线（WL）、枕孔线（ML）评估垂直脱位情况，测量寰齿间距（ADI）距离评估水平脱位情况，测量颈髓角（CMA）评估脊髓受压情况。19例平均随访（17.47±6.65）个月。结果 末次随访时，症状明显改善17例，有改善但不明显2例。至末次随访JOA评分[（15.63±1.12）分]明显高于术前[（11.00±2.40）分；P<0.05]。神经功能改善率平均76%，其中优14例（73.68%），良5例（26.32%）。术前Ranawat分级为Ⅱ级7例、ⅢA级11例、ⅢB级1例；末次随访时Ⅰ级14例，Ⅱ级5例。19例末次随访时均获得50%以上的复位，其中18例CL完全复位，16例WL完全复位，15例ML完全复位，17例ADI完全复位，17例CMA恢复正常。结论 直接后路加压器械撑开复位枕颈融合术治疗颅底凹陷症伴寰枢椎脱位，不仅能够显著改善脊髓受压情况，而且能够达到良好复位     

Outcomes of single-level cervical disc arthroplasty versus anterior cervical discectomy and fusion

Several studies have established the short-term safety and efficacy of cervical disc arthroplasty (CDA) as compared to anterior cervical discectomy and fusion (ACDF). However, few single-center comparative trials have been performed, and current studies do not contain large numbers of patients. We retrospectively reviewed all patients from a single military tertiary medical center between August 2008 to August 2012 who underwent single-level CDA or single-level ACDF and compared their clinical outcomes and complications. A total of 259 consecutive patients were included in the study, 171 patients in the CDA group with an average follow-up of 9.8 (±9.9) months and 88 patients in the ACDF group with an average follow-up of 11.8 (±9.6) months. Relief of pre-operative symptoms was 90.1% in the CDA group and 86.4% in the ACDF group with rates of return to full pre-operative activity of 93.0% and 88.6%, respectively. Patients who underwent CDA had a higher rate of persistent posterior neck pain (15.8% versus 12.5%), and patients who underwent ACDF were at risk for symptomatic pseudarthrosis at a rate of 3.4%. Reoperation rates were higher in the ACDF group (5.7% versus 3.5%). To our knowledge, this review is the largest, non-funded, comparison study between single-level CDA and single-level ACDF. This study demonstrates that CDA is a safe and reliable alternative to ACDF in the treatment of cervical radiculopathy and myelopathy resulting from spondylosis and acute disc herniation.     

Could self-locking stand-alone cage reduce adjacent-level ossification development after aneterior cervical discectomy and fusion?

Numerous studies have shown that cervical arthrodesis is associated with the adjacent-segment pathology (ASP), such as adjacent-level ossification development (ALOD). However, it still remains largely unclear whether the self-locking stand-alone implant system can reduce the incidence of ALOD. In the present study, we prospectively recruited 120 patients with cervical degenerative disc disease (CDDD) who were treated by anterior cervical discectomy and fusion (ACDF). These patients were randomly and evenly divided into the ROI-C group and plate group. Clinical and radiologic follow-up was performed at 3, 6, 12, 24 and 36 months after surgery. Clinical evaluation included preoperative and postoperative assessments of Japanese Orthopaedic Association (JOA) score and Neck Disability Index (NDI) score. The presence and severity of ALOD, as well as the C2-7 Cobb angle, were assessed on the lateral cervical films during follow-up. There were no significant differences in JOA and NDI scores at each time point during the follow-up period between the two groups. ALOD occurred in 8.8% of 58 patients and 6.7% of 104 levels in the cage group. Moreover, ALOD occurred in 20.1% of 57 patients and 17.8% of 101 levels in the plate group. The ALOD was more serious in the plate group compared with the cage group. The C2-7 Cobb angle was significantly improved compared with that before the operation and could be maintained during the follow-up in both groups. The self-locking stand-alone cage was efficacious for ACDF, and it could reduce the incidence of ALOD compared with anterior plate and cage.     

Bryan人工颈椎间盘置换与椎间融合治疗颈椎病的中期疗效比较

背景：国内外有许多相关报道颈人工椎间盘置换治疗颈椎病取得了非常好的近期临床疗效，但因其刚刚开展不久，缺乏长期随访结果。 目的：观察Bryan人工颈椎间盘置换治疗颈椎病的临床和影像学结果及邻近节段活动度的情况，并与椎间融合治疗方法比较。 设计、时间及地点：回顾性病例分析，于2004-10/2006-04在河北医科大学第三医院脊柱外科完成。 对象和方法：22例患者行Bryan假体置换（置换组），同期行常规颈前路椎间盘切除减压植骨融合内固定患者30例（融合组）。在术后1周、3个月、6个月、12个月、24个月进行随访，在每一次随访中拍摄颈椎前屈后伸位、左右侧屈位X射线片，观察置换组假体稳定性及融合组融合节段骨性融合情况。 主要观察指标：①材料与宿主的生物相容性。②临床疗效评估。 结果：全部病例随访最短24个月，平均30.6个月。①融合组患者术后6个月植骨全部骨性融合；内固定无松动、脱落、断裂的发生。置换组患者置换后无假体移位、脱落等并发症发生。②两组患者随访时神经功能均得到明显恢复，两组JOA评分差异无显著性意义（P > 0.05）。③置换组1例患者随访2年发生椎间自发融合，置换节段活动丢失；其余21例患者置换节段活动度与置换前差异无显著性意义（P > 0.05）。④融合组术后邻近节段的活动度较术前明显增大（P < 0.05）；而置换组置换前后邻近节段活动范围差异无显著性意义（P > 0.05）。 结论：与前路融合方法比较，中期随访结果显示Bryan人工颈椎间盘置换治疗颈椎病在取得满意临床疗效的同时能保留置换节段的活动，且避免了置换后上下邻近节段活动度的增加。     

A multicenter retrospective research of anterior debridement,decompression, bone grafting,and instrumentation for cervical tuberculosis

ABSTRACT

Objective: To observe the clinical effect of anterior debridement, decompression, bone grafting, and instrumentation for cervical spinal tuberculosis in four hospitals.

Materials and Methods: This research retrospectively analyzed 146 patients with cervical spinal tuberculosis who were treated by anterior debridement, decompression, bone grafting, and instrumentation in four institutions between January 2000 and January 2015. There were 68 males and 78 females with an average age of 31.32 ± 11.69 years. All patients received chemotherapy for 18 months after surgery, and fixed by brace for 3 months. Clinical outcome, laboratory indexes and radiological results were analyzed to evaluate the efficacy of anterior approach surgery in the treatment of cervical spinal tuberculosis.

Results: All cases were followed up about 18 to 52 months later (average 24 months). At the last follow-up, all patients obtained bone fusion, pain relief and neurological recovery. There was no recurrence in any of the patients, and no complications related to internal fixation. There were statistically significant differences before and after treatment in terms of Visual analog scale (VAS), Neck disability index (NDI) and Japanese Orthopedic Association (JOA)(P < 0.05). During the last follow-up examination, in 83 patients with neurological deficit, 78 patients improved. The kyphosis was significantly improved postoperatively (P < 0.05). At the last follow-up, the Cobb angle had some degree of correction loss, but the difference was not statistically significant.

Conclusion: Our study suggests that one-stage anterior debridement, decompression, bone grafting, and instrumentation are safe and effective methods in the surgical management of cervical spinal tuberculosis.

Abbreviation: VAS: Visual Analog Scale; JOA: Japanese Orthopaedic Association; NDI: Neck Disability Index; ESR: Erythrocyte Sedimentation Rate; ASIA: American Spinal Injury Association; TB: Tuberculosis