钩椎关节切除减压在治疗颈椎病中的意义

目的　探讨钩椎关节切除减压在混合型颈椎病手术中的效果。方法　回顾性分析 1997年 9月～ 1999年 3月对临床表现以脊髓型为主的混合型颈椎病 17例共 35个钩椎关节退变、增生刺激压迫周围神经、血管、脊髓 ,在颈椎前路减压同时行钩椎关节切除减压椎间植骨融合术。随访 6～ 2 0个月。结果　按临床表现、自我感觉及神经系统检查分优 9例 ,良 8例 ,尚可 0例 ,差 0例。结论　钩椎关节切除减压在混合型颈椎病手术治疗中是有效、安全的方法     

钩椎关节切除减压在治疗颈椎病中的意义

目的 探讨钩椎关节除减压在混合型颈椎病手术中的效果。方法 回顾性分析１９９７圻９月￣１９９９年３地临床表现以脊髓型为主的混合型颈椎病１７例共３５个关节退变、增生刺激压迫周围神经、血管、脊髓,在颈椎前路减压同时行钩椎关节切除减压椎间植骨融合术。随访６￣２０个月。结果 按临床表现、自我感染及神经系统检查分优９例,良８例,尚可０例,差０例。结论 钩椎关节切除减压在混合型颈椎病手术治疗中是有效、安全的方法     

前路钩椎关节切除在颈椎病治疗中的初步应用

目的探讨前路钩椎关节切除治疗脊髓型伴神经根型颈椎病的有效性和安全性.方法 2002年3月～2004年7月,收治脊髓型伴神经根型颈椎病9例,男5例,女4例,年龄38～66岁.病程11～63个月.其中单侧神经根受压6例,双侧神经根受压3例.双下肢肌力3级,行走困难3例;双下肢肌力4级,行走不稳或缓慢6例.采用前路钩椎关节切除神经根减压,椎间盘切除脊髓减压,钛网植骨钢板螺钉内固定术.结果术中无椎动脉损伤.患者均获随访3～16个月,根性神经痛消失7例,2例仍残留局部酸胀疼痛.6例双下肢肌力4 级,3例双下肢肌力4级.CT扫描或X线片示椎间孔均有扩大,MRI显示脊髓及神经根压迫解除.结论钩椎关节切除能对神经根直接减压.熟悉局部解剖,掌握手术技巧是避免损伤椎动脉的关键.     

钩椎关节应用解剖测量及辅助钩椎关节融合器参数设计

目的利用CT三维重建技术对钩椎关节区域进行应用解剖测量研究,并辅助钩椎关节融合器参数设计。方法通过病历与影像系统筛选,纳入符合选择标准的60例患者颈椎CT扫描数据,其中男30例,女30例;年龄39～60岁。将DICOM格式原始数据导入Mimics19.0软件进行三维重建,测量C_3～C_7双侧钩突高、钩突基底宽、钩突基底长、钩椎关节椎间孔部移行距离,C_3～C_7钩椎关节前缘间距、钩椎关节后缘间距,以及C_(2、3)～C_(6、7)钩椎关节间隙高度、椎间隙中心高度、椎间隙前后径。将上述测量结果用SPSS22.0统计软件计算均值、标准差、最小值和最大值,用于辅助钩椎关节融合器参数设计。结果 C_3～C_7各椎体钩突高、钩突基底宽、钩突基底长、钩椎关节椎间孔部移行距离以及C_(2、3)～C_(6、7)钩椎关节间隙高度左右侧比较,差异均无统计学意义(P0.05);钩椎关节间隙高度男女差异亦无统计学意义(P0.05)。C_3～C_7各椎体钩椎关节前缘间距均显著大于钩椎关节后缘间距(P0.05),钩椎关节向后呈内聚形状。各节段椎间隙中心高度男性高于女性,但仅C_(2、3)和C_(5、6)节段差异有统计学意义(P0.05);各节段椎间隙前后径男性均显著大于女性(P0.05)。椎间隙中心高度为(4.94±0.49) mm (3.81～5.90 mm),椎间隙前后径为(15.78±1.23) mm (12.94～18.85 mm),钩椎关节前缘间距为(17.19±2.39) mm (13.39～24.63 mm),钩椎关节后缘间距为(10.84±2.12) mm (7.19～16.64 mm)。根据上述测量结果设计钩椎关节融合器体部高度为5、6、7、8 mm 4种规格,深度为12、13、14、15、16 mm 5种规格,宽度为14～18 mm;两翼设计为弧形且宽2、3 mm两种规格。结论不同节段钩椎关节解剖测量指标存在一定差异,基于解剖研究测量结果设计的钩椎关节融合器规格能够满足不同患者需求。     

前外侧钩椎关节切除椎间植骨融合术治疗神经根型颈椎病

[目的]探讨前外侧钩椎关节切除椎间植骨融合术手术方法及疗效.[方法]对26例症状典型、定位明确的神经根型颈椎病,男14例,女8例,年龄45～75岁,平均59.6岁,采用前外侧钩椎关节切除椎间植骨融合术,术后平均随访时间2年以上,观察症状恢复及内固定骨融合情况.[结果]术后随访15～28个月,平均24个月,采用JOA评分:术前评分为12.19±0.80,术后 14.69±0.79,手术前后JOA评分具有显著性差异(P＜0.05).其中,优18例,良6例,可2例,优良率为92.3%.术后随访时复查X线片,生理曲度恢复,均植骨融合,无内固定松动、脱出等并发症.[结论]前外侧钩椎关节切除椎间植骨融合术治疗神经根型颈椎病,操作安全可靠,创伤小,减压彻底,疗效满意,能显著提高患者生活质量,可作为治疗神经根型颈椎病的一种有效术式.     

颈前路钩椎关节减压联合改良植骨术治疗颈椎病

目的:比较钩椎关节减压改良植骨术和常规颈前路椎体次全切除自体髂骨移植融合术治疗颈椎病的疗效。方法:回顾性分析2008年7月～2009年6月收治的137例连续两个节段受压的颈椎病患者,按治疗方法分为两组,A组61例采用颈前路单椎体次全切除钩椎关节减压+填充自体碎骨的异体腓骨支撑植骨+椎间隙四角局部自体骨移植+颈前路钢板内固定的方法进行治疗。B组76例,采用传统颈椎前路椎体次全切除自体髂骨移植术治疗。比较两组患者围手术期情况(住院天数、手术时间、出血量、并发症)、临床疗效(NDI、VAS评分)及影像学结果(手术节段高度、弧度及融合率)。结果:A组手术切除节段1例在C3,15例在C4,26例在C5,19例在C6;B组手术切除节段1例在C3,23例在C4,32例在C5,20例在C6。A组手术时间(103.6±21.7min)和术后住院天数(3.0±0.8d)及围手术区并发症发生率(9.8%)明显低于B组(分别为147.4±28.3min、5.2±1.1d和25.0%)(P<0.05);A组术中出血量(182.7±46.4ml)小于B组(227.7±42.2ml),但两组差异无显著性(P>0.05);两组患者术前术后NDI及VAS评分无显著性差异,单纯分析混合型颈椎病和神经根型颈椎病患者A组疗效优于B组;两组手术节段弧度及高度无明显差异;A组58/61例(95.1%)融合,B组76/76例(100%)融合,差异无统计学意义,B组术后10例出现供骨区血肿,1例感染。结论:颈椎前路钩椎关节减压改良植骨术与传统颈前路椎体次全切除自体髂骨植骨术在临床疗效及术后融合率方面无显著性差异,但前者更适用于伴有神经根管狭窄的神经根型颈椎病或者混合型颈椎病,且可显著缩短手术时间、术后住院天数并降低围手术期并发症发生率。     

颈前路术中钩椎关节切除减压治疗神经根型颈椎病的疗效分析

目的:分析颈前路术中钩椎关节切除减压治疗神经根型颈椎病的临床疗效。方法:对2007年1月至2009年12月收治的56例神经根型颈椎病患者进行回顾性分析,其中男33例,女23例;年龄41～72岁,平均(58.83±8.01)岁;病史5～48个月,平均(14.09±8.54)个月。手术方法为颈前路椎体次全切减压植骨融合术,术中予以双侧钩椎关节切除减压。分析内容为围手术期指标(包括住院天数、失血量、手术时间),影像学改变(包括椎体高度、前凸角和术后植骨融合率)、神经功能情况(JOA评分改善情况)。结果:所有患者获得随访,时间12～30个月,平均18.2个月。患者的住院天数、失血量、手术时间分别为(4.42±0.25)d、(195.51±23.67)ml、(145.52±28.29)min。椎体高度术前、术后1年分别为(5.19±0.03)cm和(5.37±0.29)cm,差异无统计学意义(P>0.05);前凸角从术前(1.53±0.03)°增加到术后1年的(7.78±0.66)°(P<0.01),术后1年植骨融合率96.5%。术前JOA评分为8.69±2.13,术后1年随访时提高到15.58±2.45(P<0.001)。根据JOA评分标准进行疗效评定:优20例,良28例,可7例,差1例。结论:颈前路术中钩椎关节切除减压手术安全、可行,适用于伴有根管狭窄和钩椎关节骨赘增生的颈椎病患者。     

前路减压椎间植骨融合内固定术治疗神经根型颈椎病保留钩椎关节的可行性分析

目的研究前路减压椎间植骨融合术(Anterior cervical decompression and fusion,ACDF)治疗神经根型颈椎病术中保留钩椎关节的可行性。方法纳入2014年4月~2016年4月行ACDF治疗的72例神经根型颈椎病患者,将术中保留钩椎关节的32例患者设为观察组,切除钩椎关节的40例设为对照组。随访2年,比较两组患者临床疗效及,植骨融合情况。结果两组术后3个月、6个月、2年的NDI指数、VAS评分均显著低于治疗前,JOA评分显著高于治疗前,差异有统计学意义(P0.05),但组间差异无统计学意义(P0.05);观察组手术优良率为87.50%,对照组为90.00%,组间差异无统计学意义(P0.05);两组吞咽不适、切口感染、慢性疼痛等并发症发生率差异无统计学意义(P0.05);观察组的植骨融合效果略优于对照组,但差异无统计学意义(P0.05)。结论 ACDF手术能显著改善神经根型颈椎病疼痛症状及颈椎功能,保留钩椎关节能获得与切除钩椎关节相同的近期疗效,且手术安全有效。     

颈椎钩椎关节融合器初始稳定性生物力学测试

目的测试颈椎钩椎关节融合器的初始稳定性。方法将20具山羊颈椎标本随机分为完整颈椎组、自体髂骨块植入组、钩椎关节融合器植入组、传统椎间融合器植入组四组,采用非破坏弹性法对山羊C_(3～4)节段进行过伸/过屈、左右侧屈以及轴向旋转活动范围(range of motion,ROM)测试。结果钩椎关节融合器组、零切迹融合器对照组在前屈、后伸、左右侧屈、轴向旋转维度上角位移与髂骨块植入组均差异有统计学意义(P0.05);钩椎关节融合器组和零切迹融合器对照组过伸/过屈ROM差异无统计学意义(P0.05),但钩椎关节融合器组左右侧屈ROM和左右旋转ROM略小于零切迹融合器对照组,差异有统计学意义(P0.05)。结论钩椎关节融合器在左右侧屈与轴向旋转方面稳定性略优于传统零切迹椎间融合器,在前屈/后伸方面与传统零切迹椎间融合器稳定性相当。     

颈椎前路减压融合术联合钩椎关节部分切除在神经根型颈椎病治疗中的应用

目的 评价颈椎前路减压融合术（anterior cervical decompression and fusion, ACDF）联合钩椎关节部分切除术治疗神经根型颈椎病的临床疗效。方法 回顾性分析2013年9月至2017年7月我科收治并进行手术的神经根型颈椎病病人76例,平均年龄为47.2岁;其中男43例,女33例。行ACDF联合钩椎关节部分切除者49例,纳入联合组;行单纯ACDF手术者27例,纳入单纯ACDF组。对其手术时间、术中出血量及手术前后C₂~C₇ Cobb角、颈部及上肢疼痛视觉模拟量表（visual analogue scale, VAS）评分、颈椎功能障碍指数（neck disability index, NDI）、植骨融合情况等进行统计分析,评价并比较两种手术方式的疗效。结果 随访时间为12~24个月,平均18个月。联合组1例病人出现C5神经根麻痹,余均无明显的神经功能损害等严重并发症;1例术后伤口内血肿,予以再次手术清除血肿。联合组手术时间为（123.74±10.19） min,术中出血量为（343.93±72.29） ml;单纯ACDF组手术时间为（108.00±10.50） min,术中出血量为（299.40±49.31） ml。所有病人术后Cobb角较术前明显增大,末次随访时Cobb角未见明显丢失;所有病人术后、末次随访时的VAS评分、NDI均较术前明显改善;两组间术前、术后及末次随访时的VAS评分比较,差异均无统计学意义（P均＞0.05）,但联合组术后的VAS评分优于单纯ACDF组;而联合组术后NDI较单纯ACDF组改善更显著,差异有统计学意义（P＜0.001）。所有病人末次随访时均植骨融合。结论 ACDF联合钩椎关节部分切除术治疗伴有钩椎关节增生、神经根管狭窄的神经根型颈椎病,与单纯ACDF相比,可以更快地缓解病人疼痛,提高病人生活质量,是一种安全、有效的治疗方法。     

保留与切除钩椎关节在颈前路手术的临床效果比较

[目的]探讨颈前路减压植骨融合术(ACDF)中保留与切除钩椎关节减压治疗神经根型颈椎病患者的临床效果。[方法]回顾性分析2010年08月~2015年12月接受1个或者2个节段的颈前路减压椎间植骨融合内固定术的86例神经根型颈椎病患者,根据是否对钩椎关节椎间孔进行部分切除,29例患者列入钩椎保留组,57例患者列入钩椎减压组。采用日本骨科协会评分(JOA)评估治疗分数、颈椎功能障碍指数(NDI)评分、颈部及上肢疼痛视觉模拟评分(VAS)对治疗效果进行评价并比较。[结果]86例患者均顺利完成手术,术中未出现椎动脉损伤、神经根损伤及硬膜破裂情况。所有患者随访15~85个月,平均(20.2±3.6)个月。所有患者随访期间均达到骨性融合,钢板无松动。两组术后的JOA、VAS、NDI评分均较术前明显改善(P0.05),两组间比较差异无统计学意义(P0.05)。钩椎保留组优27.59%,良55.17%,一般13.79%,差3.45%;钩椎减压组优28.07%,良54.39%,一般14.04%,差3.51%.[结论]神经根型颈椎病患者在颈前路手术中,保留钩椎关节椎间撑开减压可获得与切除钩椎关节减压同样良好的临床效果。因此,神经根型颈椎病患者实施颈前路减压融合术(ACDF)不应常规切除钩椎关节。     

颈椎人工椎间盘置换术与颈椎前路椎间盘切除融合术治疗颈椎病的研究进展

颈椎前路椎间盘切除融合术（ACDF）是治疗颈椎病的经典术式,疗效明确,但因责任节段融合引起相邻节段椎间盘压力及未融合节段活动范围增加,导致术后手术关节活动度（ROM）欠缺、邻近节段退行性变（ASD）加速等。针对融合术式存在的弊端,非融合技术颈椎人工椎间盘置换术（CTDR）应运而生,应用于颈椎病的治疗,疗效可靠,可在完成神经减压后保留手术节段ROM,恢复椎间盘高度,降低邻近节段ASD的发生率,克服了ACDF的固有局限^[1-3]。CTDR有明确的适应证和禁忌证^[4],而ACDF的禁忌证较少,2种术式的优劣目前尚无定论。自2005年开始,多个研究中心围绕CTDR和ACDF的疗效优良率、关节ROM、颈椎功能障碍指数（NDI）等方面展开分析比较,得出2种术式的临床疗效相似的结论^[5-9],甚至有部分研究认为CTDR疗效优于ACDF^[10-12]。但因随访时间短,对于CTDR的疗效和预后仍存在争议^[10,13]。近年来,诸多研究^[14-19]在比较CTDR与ACDF预后的同时,还围绕2种术式的医疗支出、恢复周期、运动功能等展开讨论,为术式的个性化选择提供依据。     

单侧双通道脊柱内镜技术治疗颈椎病的研究进展

颈椎病是指颈椎椎间盘退行性改变及其继发的相邻结构病理改变累及周围组织结构（神经、脊髓、血管等）,并出现与影像学改变相应的临床表现的疾病。根据不同组织结构受累而出现不同临床表现,颈椎病可分为神经根型、脊髓型、颈型和其他型（包含交感神经型和椎动脉型）。其中神经根型颈椎病（cervical spondylotic radiculopathy,CSR）是最常见的类型,约占所有颈椎病的60%~70%,其次是脊髓型颈椎病（cervical spondylotic myelopathy,CSM）。虽然大多数颈椎病通过保守治疗可以缓解,但保守治疗起效慢、效果有限。手术治疗更具显著的长期益处,且手术是治疗该病的最后选择方式以及根除疼痛的最佳治疗方式。传统开放手术虽然疗效好,但手术损伤大,并发症多、恢复慢,而随着微创技术的发展,单侧双通道脊柱内镜技术（unilateral biportal endoscopy,UBE）已成功应用于腰椎相关疾病的治疗,与传统手术相比具有保留骨质更多,手术损伤更少,维持脊柱稳定性更好,缓解疼痛、减压效果明确等优势;目前应用UBE技术在治疗各型颈椎病方面已有不少探索和尝试,并取得了初步临床疗效。笔者从应用UBE治疗各型颈椎病的安全性、有效性、优缺点、注意事项及研究现状等方面进行总结分析,为广大医务工作者应用UBE治疗颈椎病提供参考。     

Intramedullary arachnoid cyst in association with cervical spondylosis: case report

Background context

Intramedullary spinal arachnoid cysts are considered to be very rare, and only 11 cases have been reported previously. Development of such a cyst in association with marked cervical spondylosis has not been reported until recently.

Purpose

Brief review of reported cases and debate on likely treatment strategy when such a cyst is associated with symptomatic spondylosis.

Study design

To report the first example of a cervicothoracic intramedullary arachnoid cyst along with a symptomatic cervical spondylosis.

Methods

Evaluation of quadriparesis in a 58-year-old female resulted in detection of a cervical spondylotic stenosis that was accompanied with an intramedullary cystic lesion. Parallel management of both pathologies was through a wide laminectomy extending from the lower edge of C3 to T2 with subsequent fenestration and partial resection of the cyst wall via an appropriate dorsal entry root zone myelotomy. Cervicothoracic instrumentation from C3 down to T2 was done to prevent postlaminectomy deformity.

Result

Histopathological findings were consistent with the diagnosis of arachnoid cyst. Postoperatively, the patient exhibited marked improvement in neurologic status.

Conclusion

Through the review of the current case, first example from the literature, we concluded that surgery should target toward the proper management of both pathologies in a single-stage operation.     

The association of cervical spondylosis and multiple sclerosis.

The diagnostic and therapeutic considerations produced by the coexistence of cervical spondylosis and multiple sclerosis are complex. We have encountered six patients, affected by both multiple sclerosis and cervical spondylosis, in whom neurosurgical procedures were performed. The diagnosis of multiple sclerosis was confirmed by a combination of clinical, neuroimmunologic, electrophysiologic, and neuroradiologic findings. The diagnosis of spondylosis with spinal cord compromise was confirmed by myelography and computed tomographic scan in all cases, and by magnetic resonance imaging in four. Surgery was followed by lasting clinical improvement in two patients, transient improvement in one, and no change in the other three. Our experience confirms that multiple sclerosis and cervical spondylosis can coexist and suggests that this coexistence may result in an interaction that compounds the deleterious effect on the nervous system. Diagnostic evaluations of patients, particularly young patients, with symptoms of cervical spondylosis should include consideration of the possible coexistence of multiple sclerosis. The evaluation of a patient with known multiple sclerosis who develops new signs of cervical spinal cord dysfunction should always include spinal neuroimaging studies. When progression of symptoms coincides with documented progression of anatomic compression, surgical intervention can yield good results.     

可吸收止血流体明胶在钩椎关节切除术中的应用

目的探讨可吸收止血流体明胶(Surgiflo~(TM))应用于钩椎关节切除术中的有效性和安全性。方法 2017年1月—2019年5月海军军医大学附属长征医院采用钩椎关节切除术治疗神经根型颈椎病患者126例,术中使用可吸收止血流体明胶止血61例(Surgiflo组),采用明胶海绵止血65例(明胶海绵组)。记录2组术中止血时间、术中出血量、术后1 d和2 d引流量、术后1 d和末次随访日本骨科学会(JOA)评分,以及术后有无过敏、感染等并发症,综合评价2组治疗效果。结果 Surgiflo组术中止血时间、术中出血量、术后1 d和2 d引流量、术后1 d JOA评分均优于明胶海绵组,差异有统计学意义(P 0.05);2组末次随访JOA评分差异无统计学意义(P 0.05)。Surgiflo组和明胶海绵组术后伤口感染发生率分别为0和1.5%(1/65)。结论可吸收止血流体明胶是一种安全、有效的止血剂,在钩椎关节切除手术中可减少术中止血时间、术中出血量、术后引流量,且围手术期症状缓解迅速,不增加伤口感染的风险。     

Comparison of clinical and radiographic outcome in instrumented anterior cervical discectomy and fusion with or without direct uncovertebral joint decompression

BACKGROUND CONTEXT: Anterior cervical discectomy and fusion (ACDF) is an established procedure for the operative treatment of cervical disc disease in patients with radiculopathy resulting from impingement from uncovertebral joint osteophytes. Studies demonstrate that direct decompression of the lesion provides good result. However, known complications include vertebral artery injury, dural tears, nerve root injury, loss of biomechanical stability and increased operative time. Other studies suggest that disc space distraction may play an important role by indirectly decompressing neural elements. Therefore, if equivalent functional outcomes can be achieved without sacrificing the uncovertebral joint, then potential morbidity and mortality could be decreased. PURPOSE: To assess and compare clinical and radiographic outcomes of patients with neck pain and cervical radiculopathy who underwent instrumented ACDF with or without direct uncovertebral joint decompression. STUDY DESIGN/SETTING: Retrospective clinical chart and radiographic review to assess clinical outcome and graft fusion in 109 patients who underwent one- or two-level ACDF with rigid anterior plate fixation. PATIENT SAMPLE: Radiographs and clinical charts for 109 patients (mean, 46 years; range, 27 to 83) who underwent ACDF with rigid anterior plate fixation were retrospectively reviewed at a single institution. Patients with radiculopathy resulting from herniated disc, spondylosis or a combination of both refractory to conservative treatment underwent surgery using a standard Smith-Robinson left-sided approach. Seventy-one patients who received direct uncovertebral joint decompression (Group 1) were compared with 38 patients without direct decompression but indirect decompression by disc space distraction (Group 2). In Group 1, 37 one-level and 34 two-level ACDFs were performed. In Group 2, 11 and 27 were one-level and two-level ACDFs, respectively. Smoking and work-related injuries involved 26.7% and 38.0% of Group 1 and 28.9% and 28.9% of Group 2, respectively. Autologous iliac crest grafts were used in 51 patients, whereas 58 patients received allograft. OUTCOME MEASURES: Independent blinded analyses of plain lateral neutral, flexion and extension radiographs were conducted to assess fusion, evaluate graft and plate and screw integrity (mean, 12 months). Clinical outcomes were reported as excellent, good, fair or poor (mean, 23 months) based on Odom's criteria. METHODS: Postoperative clinical outcome and radiographic studies of graft and instrument integrity were assessed in 71 patients undergoing ACDF with uncovertebral joint decompression and 38 patients without uncovertebral joint decompression, but with indirect decompression through disc space distraction. RESULTS: Fusion occurred in 95.8% of Group 1 and 100% of Group 2. In Group 1, 26.8% of the patients reported excellent results, 57.7% reported good results, 12.7% reported fair results and 2.8% reported poor results. In Group 2, 23.7% of the patients reported excellent results, 60.5% reported good results and 15.8% reported fair results. All nonunions reported good outcomes. Postoperative respiratory distress developed in one patient and dysphagia developed in another both from Group 1. No other complications were noted. The presence or absence of direct uncovertebral joint decompression and clinical outcome was not statistically significant (p>.05). The use of graft-type, operative level, presence of smoking and work-related injury in relation to clinical outcome was not found to be significant (p>.05). CONCLUSION: Good to excellent results were obtained in 84.5% and 84.2% of patients for Groups 1 and 2, respectively. Indirect foraminal decompression through distraction remains somewhat controversial during ACDF. However, sacrificing the uncovertebral joint can increase operative time and potentially increase complication rates. This study demonstrates that ACDF with or without direct uncovertebral joint decompression can provide good clinical results for neck pain with cervical radiculopathy. Therefore, routine direct uncovertebral joint decompression should not be undertaken during ACDF.     

退变颈椎椎间盘纤维环成纤维细胞成骨分化与颈椎病

颈椎病是一种缓慢进展的退行性病变。现有研究认为该病是以颈椎椎间盘退变为基础病理进而造成椎间隙变窄、关节囊松弛以及进行性骨赘形成,进而分别刺激、压迫相邻的颈脊神经根、颈脊髓,椎动脉、椎旁交感神经等神经血管组织所致。前人对于颈椎椎间盘的退变研究主要集中在髓核,对于颈椎椎间盘纤维环退变后的转归及加速退     

青年颈椎病的临床特点及手术治疗

目的:探讨青年颈椎病的发病特点及手术治疗效果.方法:2002年1月～2007年6月在我院住院治疗的30岁以下的颈椎病患者30例,男26例,女4例;农民5例,工人4例,办公室职员11例,学生2例,无固定职业7例,杂技演员1例.发病至手术时间1～36个月,平均10个月.回顾分析其发病过程、临床表现、治疗经过,根据JOA 17分评分或VAS评分标准随访治疗效果.结果:手术治疗的青年颈椎病患者占同期颈椎病手术治疗病例的0.75%.脊髓型24例,神经根型2例,脊髓型合并交感型4例.伏案工作者占43%,合并发育性椎管狭窄10例,椎间盘退变27例,颈椎不稳2例.前路减压融合固定11例,前路减压人工椎间盘置换9例;后方入路C3～C7单开门椎管扩大成形术6例;前后联合手术4例.1例术后出现C5神经根麻痹症状,3d后缓解,未发生其他手术相关并发症.所有患者术后症状均明显改善,脊髓型患者JOA评分由13分提高到16.7分,改善率为93%;神经根型患者VAS评分由8分改善到0分,改善率为100%.平均随访34个月,均恢复原工作,行椎间融合者未发生内固定松动脱落断裂及固定相关并发症,椎间盘置换者未出现内置物松动脱落及相关并发症,1例出现轻度头晕,但不影响工作.结论:青年颈椎病多发于长期伏案工作人群,椎间盘退变突出和发育性椎管狭窄是主要致病因素,针对致病因素采取前路椎间盘切除减压椎间融合或非融合或/和后路椎板成形术可取得满意疗效.