经皮髓核成形术与椎间盘切除术治疗退变性颈椎间盘突出症

目的比较经皮髓核成形术与经皮椎间盘切除术治疗退变性颈椎间盘突出症的临床疗效及对颈椎稳定性的影响。方法2002年7月至2004年12月共收治退变性颈椎间盘突出症患者80例,行经皮髓核成形术42例(PCN组),经皮椎间盘切除术38例(PCD组)。回顾性分析两组的临床资料,比较两组在手术时间、临床效果及颈椎稳定性等的差异。结果所有病例随访6~26个月,PCN组平均(12±5)个月;PCD组平均(12±4)个月。两组手术均获成功。两组手术时间有显著差异(t=-21·70,P=0·000);两组手术临床效果(JOA评分)经自身配对t检验显示均有显著性差异(PCN:t=14·05,P=0·000;PCD:t=-14·79,P=0·000),即两组均有效;两组手术临床效果(Williams评分)经Kruskal-Wallis检验无显著差异(z=-0·377,P=0·706,>0·05),即两组临床效果相似。两组手术后均无颈椎不稳病例发生,颈椎稳定性手术前后均无显著差异(P>0·05)。结论经皮髓核成形术与经皮椎间盘切除术治疗颈椎间盘突出症的临床疗效优良,对颈椎稳定性影响小,不会造成颈椎失稳的发生。     

经皮微创技术治疗颈椎间盘突出症

 目的 比较经皮颈椎间盘切除术(percutaneous cervical discectomy, PCD)、经皮颈椎间盘髓核成形术(percutaneous cervical disc nucleoplasty, PCN)与联合使用两种微创技术(percutaneous cervical discectomy and nucleoplasty, PCDN)治疗颈椎间盘突出症的临床疗效及其对颈椎稳定性的影响。方法 回顾性分析 2003年 2月至 2011年 4月收治的退变性颈椎间盘突出症患者 171例。年龄 21~74岁, 平均 47.8岁。 171例患者分为三组: PCD组 97例, 男 53例, 女 44例;PCN组 50例, 男 29例, 女 21例; PCDN组 24例, 男 15例, 女 9例。比较三组的临床效果及颈椎稳定性。结果所有病例中位随访 4.1年: PCD组 4.2年, PCN组 2.6年, PCDN组 3.3年。三组手术均获成功。三组手术临床效果(JOA评分), 经手术前后配对 t检验示差异均有统计学意义(PCD: t=21.85, P 0.05)。结论 应用 PCD、PCN以及联合使用这两种微创技术的 PCDN治疗颈椎间盘突出症的临床疗效优良, 对颈椎稳定性影响小, 不会造成颈椎失稳的发生。     

经皮穿刺颈椎髓核成形术治疗多间隙颈椎间盘突出症

目的:探讨经皮穿刺颈椎髓核成形术(percutaneous cervical nucleoplasty,PCN)治疗多间隙颈椎间盘突出症的临床疗效及其对颈椎稳定性的影响。方法:对我院2003年7月～2005年6月因颈椎间盘突出症住院行PCN治疗的64例患者进行回顾性研究,根据手术间隙分为两组:单间隙组(A组)34例,多间隙组(B组)30例。临床效果评价采用JOA评分标准(17分制并计算改善率),颈椎稳定性评价采用Katsumi标准。比较两组的临床效果及颈椎稳定性。结果:随访6～24个月,A组平均14.1±3.7个月,B组平均13.9±3.8个月,A组术前JOA评分为9.19±2.64分,术后为14.37±1.42分,改善率为66.3%;B组术前JOA评分为8.89±2.31分,术后为14.33±1.28分,改善率为67.1%,与术前比较均有显著性差异(P<0.001),两组患者的JOA评分改善率无显著性差异(P>0.05)。两组患者术后颈椎稳定性与术前比较均无显著性差异(P>0.05)。结论:PCN治疗多间隙颈椎间盘突出症效果优良,对颈椎稳定性影响小,不会造成颈椎失稳。     

2种微创方法治疗包容型颈椎间盘突出症的比较

目的比较经皮穿刺颈椎间盘切吸术(percutaneous cervical discectomy,PCD)和经皮穿刺射频消融髓核成形术(percutaneous coablation nucleoplasty,PCNP)治疗包容型颈椎间盘突出症的疗效、并发症、对椎间稳定性的影响。方法回顾分析2006年1月～2010年6月94例包容型颈椎间盘突出症行PCD(PCD组,n=53)和PCNP(PCNP组,n=41)的临床资料,比较PCD和PCNP治疗颈椎间盘突出症的疗效、手术并发症及对颈椎稳定性的影响。结果 94例均获得随访,PCD组平均随访13个月(5～21个月),PCNP组平均随访11个月(7～15个月)。根据改良MacNab标准,PCD组和PCNP组术后1周优良率分别为83.0%和80.5%(χ2=0.010,P=0.944),术后半年优良率分别为81.1%和78.0%(χ2=0.136,P=0.712),术后1年优良率分别为78.4%和74.4%(χ2=0.205,P=0.651)。PCD组在随访期间内有3例(5.7%)因复发性椎间盘突出改行前路颈椎间盘摘除植骨融合术(anterior cervical discectomy and fusion,ACDF),PCNP组2例(4.9%)因复发性椎间盘突出改行ACDF,2组病人术后均未出现椎间盘炎等不良事件。PCD组术前、术后1周内、术后半年、术后1年椎间高度(intervertebralheight,IVH)分别为(7.14±0.84)、(7.12±0.93)、(7.09±0.78)、(7.11±0.82)mm,与PCNP组相应时点(7.32±0.95)、(7.23±0.87)、(7.21±0.81)、(7.22±0.91)mm比较无统计学差异(P>0.05),随访未见颈椎不稳征象。结论 PCD和PCNP治疗包容型颈椎间盘突出症均能快速缓解患者临床症状。PCD和PCNP治疗颈椎间盘突出症并发症发生率低,术后IVH无明显丢失,对颈椎间的稳定性也无明显影响。PCD和PCNP是2种安全而有效的经皮椎间减压方法。     

颈椎软骨终板钙化与颈椎间盘退变和椎体骨赘形成的关系

目的：研究颈椎软骨终板钙化与颈椎间盘退变和颈椎椎体骨赘形成的关系。方法：应用组织学方法观察颈前路环锯手术切下的18例脊髓型颈椎病和4例颈椎过伸性损伤致颈椎间盘突出患者的颈椎间盘及相邻的上下椎体标本,研究不同退变程度颈椎间盘软骨终板和椎间盘的形态学变化及椎体骨赘形成过程。结果：退变程度较轻或基本正常的颈椎间盘软骨终板结构良好,潮标清晰,退变程度较重的颈椎间盘软骨终板发生明显纤维化,潮标前移,钙化软骨和软骨下骨板增厚,退变颈椎间盘周边软骨终板潮标明显前移,钙化和骨化层增厚,形成突向外侧的椎体边缘的骨赘。结论：颈椎软骨终板的不断钙化和骨化导致颈椎间盘营养发生障碍可能是启动颈椎间盘退变的关键因素,退变椎体周边软骨终板的不断钙化和骨化是椎体骨赘形成的根本原因。     

零切迹颈椎前路融合固定系统与传统融合器钢板内固定系统治疗单节段颈椎间盘突出症的病例对照研究

目的 :比较零切迹颈前路椎间融合固定系统(Zero-p)与传统钛板联合cage融合内固定术治疗单节段颈椎间盘突出症的临床疗效。方法:对2011年8月至2014年3月接受颈前路椎间盘切除植骨融合内固定术的139例单节段颈椎间盘突出症患者的临床资料进行回顾性分析,根据已采取的不同术式分为A,B两组,其中A组63例,行前路椎间盘切除与Zero-P融合内固定;B组76例,行前路椎间盘切除椎间cage融合与钢板内固定。分别于手术前后对患者进行JOA评分、Odom功能评级;采用电视透视吞咽研究(videofluorographic swallowing study,VFSS)评估患者椎前软组织厚度;采用Bazaz吞咽困难分级评估患者术后吞咽困难的发生率。术后12个月时采用颈椎正侧位X线及CT检查评估植骨融合情况,采用MRI检查评估临近节段退变情况。比较两组患者术中出血量、手术时间、手术前后JOA评分、Odom评级及VFSS中的椎前软组织厚度、术后患者吞咽困难发生率(Bazas评分)、椎体间融合率、邻近节段退变发生率。结果:手术前后两组患者的JOA评分、Odom功能评级差异比较无统计学意义(P0.05);两组患者术前VFSS中的椎前软组织厚度比较差异无统计学意义(P0.05);两组患者手术时间及术中出血量比较差异无统计学意义。两组患者VFSS中的椎前软组织厚度、吞咽困难发生率在术后第2天,术后3、6个月及末次随访时差异均有统计学意义(P0.05)。术后1年所有患者获植骨融合,两组融合率比较差异无统计学意义(P0.05)。A组8例(12.7%)出现邻近节段退变,B组19例(25%)出现临近节段退变,两组比较差异有统计学意义(P0.05)。结论:应用零切迹颈椎前路椎间融合固定系统和传统钛板联合cage融合内固定治疗单节段颈椎间盘突出症均可取得满意疗效,前者术后吞咽困难和临近节段退变发生率较低,中长期疗效有待进一步观察。     

颈椎前融合对颈椎退变的影响

本文探讨颈椎融合术导致颈椎退变加重的根本原因,以提高颈椎病患者的手术治疗效果。对实施颈椎融合术的76例颈椎间盘突出症患者和64例颈椎骨折脱位患者进行回顾性对比分析,归纳出影响颈椎融合术治疗效果的根本原因。结果显示:76例颈椎间盘突出症患者术后有33例发生颈椎退变明显加重,其中4例再次发生颈椎间盘突出症;64例颈椎骨折脱位患者术后有8例出现颈椎退变加重。作者认为:融合术前,融合节段上下端颈椎已有的退变是导致术后退变加重的根本原因,手术治疗时应给予特别的关注。     

青少年胸12腰1段椎体楔形变在下腰椎间盘退变发病中的意义

目的探讨胸12腰1段椎体楔形变在腰椎间盘退变发病中的意义,为预防青少年腰椎间盘早发退变 提供临床及理论依据。方法 随机选取腰痛青少年患者40例,均行腰椎X线和MRI检查,其中有胸12腰1段椎 体楔形变19例,无椎体楔形变21例;并根据T2加权像信号强度强弱将椎间盘分为以下三型:Ⅰ型:椎间盘呈强 信号;Ⅱ型:椎间盘呈不规则信号;Ⅲ型:椎问盘呈低信号。测量青少年腰骶角统计各型病例数,进行统计学处理。 结果 青少年胸12腰1段椎体楔形变组下腰椎间盘(L4-5、L5-S1)Ⅱ型、Ⅲ型椎间盘例数明显多于无椎体楔形变组 青少年患者,有显著性差异(P<0.01)。胸12腰1段椎体楔形变患者较无楔形变患者腰骶角明显增大,具有显著性 差异(P<0.01)。结论胸12腰1段椎体楔形变是青少年下腰椎间盘早发退变的重要诱因,防止胸12腰1段椎体楔 形变,是预防、减缓青少年腰椎间盘突出症发病的重要措施。     

颈椎不同退变程度对颈椎人工间盘置换术后椎旁骨化的影响

背景:椎旁骨化(paravertebral ossification,PO)是颈椎人工间盘置换术(cervical artificial disc replacement,CADR)后常见的并发症,目前关于颈椎不同退变程度对CADR术后PO的影响尚不明确。目的:探讨颈椎不同退变程度与Bryan人工间盘置换术后PO及手术节段活动度的关系。方法:回顾性分析2003年12月至2007年12月行单节段Bryan人工间盘置换术且随访时间超过10年的颈椎退行性疾病患者71例,男44例,女27例;年龄26~69岁,平均(45.9±8.1)岁;C3/4节段2例,C4/5节段15例,C5/6节段45例,C6/7节段9例。按术前CT及MRI结果将患者分为单纯颈椎间盘突出症组28例,退行性颈椎管狭窄症组43例。分别于术前、术后3个月及末次随访时拍摄颈椎过伸过屈位X线片并测量手术节段活动度,于末次随访时拍摄颈椎CT,并采用Mc Afee分型方法评估PO分级。比较两组患者的基本资料、手术节段活动度及PO分级的差异,采用连续变量独立样本t检验进行统计学分析,分级变量Mann-Whitney检验进行统计分析,P<0.05为有显著性差异。结果:颈椎人工间盘置换术后远期PO的发生率为93.0%(66/71),其中高等级PO的发生率为35.2%(25/71)。单纯颈椎间盘突出症组中89.3%的患者在末次随访时出现PO(25/28),其中高等级PO的发生率为10.7%(3/28);退行性颈椎管狭窄症组中95.4%的患者在末次随访时出现PO(41/43),其中高等级PO的发生率为51.2%(22/43)。单纯颈椎间盘突出症组术前手术节段活动度为9.5°±4.7°,术后3个月为11.1°±3.6°,末次随访时为10.5°±4.6°;退行性颈椎管狭窄症组术前手术节段活动度为9.8°±4.5°,术后3个月为8.6°±4.9°,末次随访时为7.3°±5.5°。两组患者术后手术节段活动度与PO分级均存在显著性差异(P<0.05)。结论:不同类型的颈椎退行性疾病会影响人工间盘置换术后PO的形成与手术节段活动度。退行性颈椎管狭窄症患者CADR术后PO的分级更高,且手术节段活动度低于单纯颈椎间盘突出症患者。     

影响慢性压迫性颈脊髓病疗效的因素

慢性压迫性颈脊髓病(Chronic cervieal com-pression myelopathy)是颈脊髓缓慢受压性损害引起的综合征,原发疾病较多,如脊髓型颈椎病、后纵韧带骨化症(OPLL)、颈椎间盘突出症及发育性椎管狭窄症等。其疗效取决于多种因素,手术方法选择、术后是否出现并发症以及疾病本身的特点均可能成为影响疗效的原因。1手术方法与疗效 有报告颈椎前、后路手术其疗效无显著性差异[1],但亦有报告颈椎椎体次全切除术其疗效明显优于颈椎前路椎间盘切除植骨融合术和颈椎后路椎板切除术,其后二种手术的疗效无显著性差异[2]。 颈椎前后路手术对改善颈脊髓病不同…     

Anterior cervical foramenotomy for cervical radiculopathy

Anterior cervical discectomy (ACD) is standard practice for cervical radiculopathy. Irrespective of the precise method used, it involves more or less complete disc removal with resultant anatomical and biomechanical derangements, and frequently the insertion of a bone or prosthetic graft. Anterior cervical foramenotomy is an alternative procedure that allows effective anterior decompression of the nerve root and lateral spinal cord, whilst conserving the native disc, preserving normal anatomy and movement, and protecting against later degeneration at adjacent spaces as far as possible. The aim of the study was to determine the safety and efficacy of anterior cervical foramenotomy in the treatment of cervical radiculopathy and took the form of a prospective study of 21 cases under the care of a single surgeon. All patients had a single level or two level anterior cervical foramenotomy. All had pre- and postoperative visual analogue scores for arm and neck pain, arm strength, sensation and overall use. A comparison between patients' perceptions and surgeon's observations was also made. Patients were followed up for between 10 and 36 months. Sixty-eight per cent completed full pre- and postoperative assessments. Twenty-eight per cent of the responders had complete arm pain resolution. There were statistically significant reductions in arm and neck pain, and overall disability. The surgeon's impression of improvement paralleled that of the patients. There was one complication with discitis. Anterior cervical foramenotomy is a safe and effective treatment for cervical radiculopathy caused by posterolateral cervical disc prolapse or uncovertebral osteophyte, and might also reduce adjacent segment degeneration.     

Posterior cervical laminoplasty formultilevel cervical spine stenosis

Cervical laminoplasty for treating multilevel spinal stenosis appears to be a good surgical alternative to the more traditional laminectomy or anterior decompression and fusion. This procedure avoids the morbidity associated with extensive anterior procedures and also appears not to be associated with late kyphosis, which can be seen in patients after a laminectomy. This review outlines the rationale, indications, contraindications, and early clinical results for patients undergoing a posterior laminoplasty.     

微创前路经上位椎体椎间孔减压术治疗神经根型颈椎病

【摘要】 目的：探讨微创前路经上位椎体椎间孔减压术治疗神经根型颈椎病的有效性。方法：2008年7月~2010年7月12例单侧神经根型颈椎病患者在延边大学医院接受微创前路经上位椎体椎间孔减压术。其中男7例,女5例,年龄为35~68岁,平均49岁。椎间孔狭窄部位：C5/6 4例,C6/7 5例,C7/T1 3例。软性髓核突出3例,钩椎关节骨质增生7例,突出的髓核钙化2例。均行前路手术,术中采用脊柱手术专用显微镜,在病变上位椎体确定钻孔起始部位,利用高速钻石气钻磨出一约6mm直径的通路达到病变区域,减压椎间孔。观察术前及末次随访时上肢放射性疼痛的VAS评分、颈椎功能障碍指数（NDI）及病变水平椎间盘高度。结果：手术时间为56~110min,平均86±6min;术中失血量为40~120ml,平均92±8ml。无椎动脉损伤、贺纳氏综合征、喉返神经损伤等并发症。术后随访时间为12~23个月,平均15.8±1.3个月。术前上肢疼痛VAS评分为8.5±0.5分（7~10分）,末次随访时为1.4±0.2分（0~3分）,两者比较有显著性差异（P<0.05）;术前NDI为26.4±1.3分（22~31分）,末次随访时为4.2±0.6分（3~8分）,两者比较有显著性差异（P<0.05）,改善率为84.1%;术前病变水平椎间盘高度为5.4±0.7mm（4.2~6.1mm）,末次随访时为4.9±0.7mm（3.6~5.8mm）,两者比较无显著性差异（P>0.05）。术后满意度为100%。结论：微创前路经上位椎体椎间孔减压术可减少对椎间盘的损伤,是治疗单侧神经根型颈椎病的有效手术方法。     

Alternating cervical laminoplasty for cervical spondylotic myelopathy

We present a novel method of performing an 'open-door' cervical laminoplasty. The complete laminotomy is sited on alternate sides at successive levels, thereby allowing the posterior arch to be elevated to alternate sides. Foraminotomies can be carried out on either side to relieve root compression. The midline structures are preserved. We undertook this procedure in 23 elderly patients with a spondylotic myelopathy. Each was assessed clinically and radiologically before and after their operation. Follow-up was for a minimum of three years (mean 4.5 years; 3 to 7). Using the modified Japanese Orthopaedic Association scoring system, the mean pre-operative score was 8.1 (6 to 10), which improved post-operatively to a mean of 12.7 (11 to 14). The mean percentage improvement was 61% (50% to 85.7%) after three years. The canal/vertebral body ratio improved from a mean of 0.65 (0.33 to 0.73) pre-operatively to 0.94 (0.5 to 1.07) postoperatively. Alternating cervical laminoplasty can be performed safely in elderly patients with minimal morbidity and good results.     

前路颈椎椎间盘切除融合术与动态装置植入术治疗单节段颈椎椎间盘突出症

目的 对比前路颈椎椎间盘切除融合术(ACDF)与颈椎前路动态装置植入术(DCI)对单节段颈椎椎间盘突出症(CDH)患者颈椎活动度(ROM)及术后颈椎曲度的影响.方法 回顾性分析2018年6月—2019年9月海军军医大学长征医院收治的78例单节段CDH患者临床资料,其中42例采用ACDF治疗(ACDF组),36例采用DC...     

颈椎不稳在交感型颈椎病发病中的作用

目的：研究交感型颈椎病的病理因素及治疗方法。方法：回顾分析了1988-2000年收治的20例手术治疗的交感型颈椎病患者。根据术前及术后颈椎伸屈侧位X光片判断有无颈椎不稳。结果：20例患者术前均有颈椎不稳,颈椎不稳主要发生在C3-C4和C4-C5,颈椎高位硬膜外封闭对大部分患者有短期效果。每例患者均于不稳节段行颈前路融合术,手术有效率为90％。结论：颈椎不稳是导致交感型颈椎病发病的重要因素;颈椎高位硬膜外封闭可有短期疗效因此具有重要的诊断价值;颈椎前路植骨融合术是治疗交感型颈椎病的有效方法。     

Anterior cervical microforaminotomy for cervical radiculopathy--results and review

Analysis of anterior cervical microforaminotomy performed at the North Staffordshire University Hospital along with a review of literature of this minimally invasive procedure is presented. METHODS: A retrospective-prospective study was performed on 34 patients (24 males, 10 females) with cervical disc disease who had been surgically treated with anterior cervical microforaminotomy between 1999 and 2005. Age ranged from 37 to 75. MRI findings were disc prolapse in 28 and additional osteophytes in six. Microforaminotomy was performed according to the published technique. RESULTS: Single level operations were performed in 22 patients (21 unilateral, 1 bilateral) and multi-level operations were performed in 12 patients (7 unilateral and 5 bilateral). The short-term outcomes were excellent in 65% (i.e., complete resolution of all symptoms), good in 29% (relief of radiculopathy but some non-radicular discomfort persists), and fair in 6% (mild residual radiculopathy with or without non-radicular symptoms). Postoperative complications include one patient with partial C6 root damage, which was identified intraoperatively, but had excellent results at 2 months post operation. Long-term follow-up (using the cervical spine research society questionnaire) ranged from 2-48 months. The average pain score, neurological outcome and functional outcome improved after this operation. RE-OPERATION: One patient, who had 2 level bilateral surgeries, needed discectomies with fusion for new onset myelopathy 18 months later. CONCLUSION: Appropriate patient selection is cardinal in achieving good outcome in anterior microforaminotomy.     

Percutaneous cervical nucleoplasty and percutaneous cervical discectomy treatments of the contained cervical disc herniation

Background  

There were no studies in literature to compare the clinical outcomes of percutaneous nucleoplasty (PCN) and percutaneous cervical discectomy (PCD) in contained cervical disc herniation.     

Postoperative instability of cervical OPLL and cervical radiculomyelopathy

The presence of cervical spine instability with respect to preoperative and postoperative changes in angular, horizontal, and rotational displacement of the vertebral body were studied. With the anterior approach, the instability in the remaining unfused segments, and their relation to the kyphotic or lordotic fused segment were studied. With the posterior approach, postoperative ROM (range of motion) could be better maintained, and horizontal displacement was improved in more cases by laminoplasty compared with laminectomy. With the anterior approach, the compensatory function for the loss of motion of the segments resulting from fusion was most remarkable at the levels of C2-3 and C6-7. In the alignment of the anterior fused segments, it appears important that the physiologic lordotic position be maintained.