脊髓型颈椎病早期诊断指标的选择及临床意义：（84例前瞻性？…

目的 探讨脊髓型颈椎病（ＣＳＭ）早期诊断的可能性，筛选预示ＣＳＭ发作的临床、影像学及电生理指标。方法 指导ＣＳＭ常见特征，选择２９项与ＣＳＭ发病有关的指标并据此建立研究对象的入选标准。对８４例符合预选指标的患者进行２￣６．５年（平均３．７年）的随访追踪观察，并将手术组与非手术组的各项指标做对照研究。结果：２９例演变为ＣＳＭ并行早期手术处理，术后疗效良好。有１３项指标与ＣＳＭ发病密切相关。结论：颈椎     

脊髓型颈椎病早期诊断的研究进展

脊髓型颈椎病 (ｃｅｒｖｉｃａｌｓｐｏｎｄｙｌｏｔｉｃｍｙｅｃｏｐａｔｈｙＣＳＭ)是严重危害中老年人健康的最常见的颈椎疾患之一[1] 。本病诊断包括 :①临床上出现颈脊髓损害的表现。②影像学证实存在脊髓压迫。③除外肌萎缩性脊髓侧索硬化症、脊髓肿瘤等疾病[2 ] 。1　ＣＳＭ早期诊断的必要性在ＣＳＭ的病理改变中 ,大部分神经纤维的脱髓鞘改变在急性损伤中被认为是可逆的 ,ＣＳＭ病灶中脱髓鞘和髓鞘再生过程同时存在 ,表明及时积极的治疗对ＣＳＭ是有意义的[3 ] 。ＣＳＭ的手术治疗被多数学者认为是解除椎管内脊髓压迫迄今为止最有效…     

脊髓型颈椎病的早期诊断

脊髓型颈椎病 (Ｃｅｒｖｉｃａｌｓｐｏｎｄｙｌｏｔｉｃｍｙｅｌｏｐａｔｈｙ ,ＣＳＭ )是由慢性颈椎间盘退变引起的一种脊髓和神经根功能障碍性疾病[1] 。它是 5 5岁以上人群中引起脊髓功能障碍的最常见病因[2 ] 。它的直接病理基础是脊髓的外部压迫和血供障碍。脊髓型颈椎病常呈隐性发病 ,颈、肩部症状轻微甚或毫无颈部症状 ,经常由于诊断和治疗不及时而导致病人生活能力的丧失[3] 。所以 ,在发病早期能及时作出诊断 ,以便采取正确的治疗和控制疾病发展的预防措施 ,具有重要的临床意义。1　脊髓型颈椎病的发病机理脊髓型颈椎病开始于脊髓…     

脊髓型颈椎病的早期诊断与治疗

脊髓型颈椎病是由颈椎间盘退变和相关病理变化引起的一种脊髓功能障碍性疾病。它是中老年人群最常见的退变性疾病,其病理基础是脊髓遭受外部压迫和脊髓血运障碍。脊髓型颈椎病常呈隐性缓慢发病,颈、肩部症状轻微甚或毫无颈部症状,经常由于患者自身忽视或医师认识不足造...     

脊髓型颈椎病早期诊断及治疗的临床研究

目的 明确脊髓型颈椎病（cervical spondylotic myeloPathy，CSM）的早期诊断，选择适当的治疗方法以取得较好疗效。方法 回顾性分析31例CSM患者的临床表现、诊断及治疗情况。结果 全组总症状缓解率达93％。心悸、气短、胸闷；头晕、头痛；颈肩痛缓解率分别为：94％；94％；85％。结论 根据患者症状、体征、神经系统检查及MRI即可做出CSM早期诊断，但需和心血管、腰椎管狭窄、神经内科等疾病鉴别。采取适当的保守或积极的手术治疗，CSM可取得较好疗效。     

脊髓型颈椎病的早期诊断与外科干预的研究进展

脊髓型颈椎病 (ｃｅｒｖｉｃａｌｓｐｏｎｄｙｌｏｔｉｃｍｙｅｌｏｐａｔｈｙ ,ＣＳＭ )是常见病、多发病。调查证明 ,如果 5 0岁左右的人群中有2 5 %的人患有颈椎病 ,到了 6 0岁可达5 0 % ,而 70岁以后则更高 ,可见这种以退行性变为基础的疾患必然随着年龄的增加而成倍递增 ,严重影响老年人的健康。近年来由于ＣＴ、ＭＲＩ等影像学技术的发展 ,对脊髓型颈椎病的认识日益加深 ,使得脊髓型颈椎病的早期诊断、手术指征、术前评估及判断预后 ,均提高到一个新的水平。1　脊髓型颈椎病的诊断何为脊髓型颈椎病 ?现代医学已有明确的概念 ,因颈椎间…     

脊髓型颈椎病早期诊断的前瞻性研究

目的探讨脊髓型颈椎病（ＣＳＭ）早期诊断的可能性,筛选预示ＣＳＭ发作的临床、影像学及电生理指标。方法根据ＣＳＭ常见特征,选择２９项与ＣＳＭ发病有关的指标并据此建立研究对象的入选标准。对８１例符合预选指标的患者进行２～６５年（平均３７年）的随访追踪观察。手术组与非手术组的各项指标行对照研究。结果有上肢疼痛、感觉异常、肢体动作灵活性丧失、动态Ｈｏｆｍａｎｎ征阳性、发育性椎管狭窄、颈椎不稳、颈椎间盘突出、中枢运动传导时间延迟等１３项指标与ＣＳＭ发病密切相关。２９例演变为ＣＳＭ并行早期手术处理,术后疗效良好。结论通过对有临床可疑指标者密切观察和随访,颈椎病的早期诊断是可能的;对其中出现神经损害征象者,宜及早手术以避免对神经功能产生不可逆性损害;早期手术有望获得良好疗效     

颈椎不同位置时Hoffmann征对脊髓型颈椎病早期诊断的意义

脊髓型颈椎病起病时症状往往较轻,且临床表现多隐匿,尤其在早期容易被临床医生忽视。因此,寻找灵敏性较高的神经系统阳性体征用于物理诊断,无疑具有重要价值。１９９１年Ｄｅｎｎｏ首先报道了动态Ｈｏｆｍａｎｎ征在脊髓型颈椎病早期诊断中的作用,他发现颈椎处于中立...     

Noncontiguous anterior decompression and fusion for multilevel cervical spondylotic myelopathy: a prospective randomized control clinical study

Anterior decompression and fusion is an established procedure in surgical treatment for multilevel cervical spondylotic myelopathy (MCSM). However, contiguous corpectomies and fusion (CCF) often induce postoperative complications such as nonunion, graft subsidence, and loss of lordotic alignment. As an alternative, noncontiguous corpectomies or one-level corpectomy plus adjacent-level discectomy with retention of an intervening body has been developed recently. In this study, we prospectively compared noncontiguous anterior decompression and fusion (NADF) and CCF for MCSM in terms of surgical invasiveness, clinical and radiographic outcomes, and complications. From January 2005 to June 2007, 105 patients with MCSM were randomized to NADF group (n = 55) and CCF group (n = 50), and followed up for average 31.5 months (range 24–48 months). Average operative time and blood loss decreased significantly in the NADF group as compared with those in the CCF group (p < 0.05 and <0.001, respectively). For VAS, within 3 months postoperatively, there was no significant difference between the two groups. But at 6 months after surgery and final follow-up, VAS improved significantly in NADF group than that in CCF group (p < 0.05). No significant difference of JOA score was observed between the two groups at every collection time. In NADF group, all 55 cases obtained fusion at 1 year after operation (average 5.1 months). In CCF group, 48 cases achieved fusion 1 year postoperatively, but the other 2 cases were performed posterior stabilization and achieved fusion 6 months later. The differences of cervical lordosis between two groups were insignificant at the same follow-up time. But the loss of lordosis and height of fusion segments in 6 months postoperatively and final follow-up were significantly more in CFF group than in NADF group (p < 0.001). Complications were similar in both groups. But in CCF group three cases needed reoperation, one case with extradural hematoma was immediately re-operated after anterior decompression and two cases mentioned above were performed posterior stabilization at 1 year postoperatively. In conclusion, in the patients with MCSM, without developmental stenosis and continuous or combined ossification of posterior longitudinal ligaments, NADF and CCF showed an identical effect of decompression. In terms of surgical time, blood loss, VAS, fusion rate and cervical alignment, NADF was superior compared with CCF.     

脊髓型颈椎病磁刺激运动诱发电位的临床研究

目的：为脊髓型颈椎病（ＣＳＭ）早期诊断寻找一种客观、敏感的检查方法。方法：采用磁刺激运动诱发电位（ＭＥＰ）和电刺激Ｆ波相结合的方法，测定１９例脊髓型颈椎病人外展拇短肌（ＡＰＢ）和胫前肌（ＡＴ）的中枢运动传导时间（ＣＭＣＴ），并与２０例正常受试者作对照。结果：１８例（９４．７％）ＣＳＭ病人上、下肢ＭＥＰ异常，ＡＰＢ肌及ＡＴ肌ＣＭＣＴ明显延迟，并与临床功能障碍（ＪＯＡ评分）显著相关，与ＭＲＩ所示脊髓受压程度无相关性。结论：磁刺激ＭＥＰ作为检测ＣＳＭ患者运动功能状态的客观指标具有重要的诊断价值。     

Neurological recovery after surgical decompression in patients with cervical spondylotic myelopathy - a prospective study

Cervical spondylotic myelopathy is a common clinical problem. No study has examined the pattern of neurological recovery after surgical decompression. We conducted a prospective study on the pattern of neurological recovery after surgical decompression in patients with cervical spondylotic myelopathy. Patients suffering from cervical spondylotic myelopathy and requiring surgical decompression from January 1995 to December 2000 were prospectively included. Upper limbs, lower limbs and sphincter functions were assessed using the Japanese Orthopaedic Association (JOA) score. Assessment was done before the operation, at 1 week, 2 weeks, 1 month, 3 months, 6 months, 1 year and then yearly after surgery. Results were analysed with the t-test. Differences with P-values less than 0.05 were regarded as statistically significant. Fifty-five patients were included. The average follow-up period was 53 months. Thirty-nine patients (71%) had neurological improvement after the operation with a mean recovery rate of 55%. The JOA score improved after surgery, reaching statistical significance at 3 months and a plateau at 6 months. Thirty-six patients (65%) had improvement of upper limb function. Twenty-four patients (44%) had improvement of lower limb function. Eleven patients (20%) had improvement of sphincter function. The recovery rate of upper limb function was 37%, of lower limb function was 23% and of sphincter function was 17%. Surgical decompression worked well in patients with cervical spondylotic myelopathy. Seventy-one percent of patients had neurological improvement after the operation. The neurological recovery reached a plateau at 6 months after the operation. The upper limb function had the best recovery, followed by lower limb and sphincter functions.

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Résumé Les myélopathies cervicales sont un problème courant. Aucune étude n’a examiné la récupération neurologique après décompression chirurgicale. Nous avons conduit une étude prospective sur ce sujet, chez des patients ayant bénéficié d’une décompression pour myélopathie cervicale. Les patients opérés entre janvier 1995 et décembre 2000 ont été inclus dans cette étude. Les fonctions des membres supérieurs, des membres inférieurs et les fonctions sphinctériennes ont été évaluées selon le score de la JOA (Association Japonaise d’Orthopédie). L’évaluation a été réalisée avant l’opération, une semaine, deux semaines, un mois, trois mois, six mois, un an et chaque année après l’intervention chirurgicale. Les résultats ont été analysés selon le P test et en appréciant ensuite les résultats statistiquement ou non statistiquement significatifs. Cinquante-cinq patients ont été inclus. Le suivi moyen a été de 53 mois, 39 patients (71%) ont montré une amélioration neurologique après l’intervention avec un taux de récupération complète de 55%. Le score de la JOA a été amélioré à 3 mois avec un plateau de récupération à 6 mois. Trente-six patients (65%) ont vu une amélioration au niveau des fonctions du membre supérieur, 24 (44%) au niveau des membres inférieurs, 11 (5%) au niveau des fonctions sphinctériennes. Le taux de récupération au niveau des membres supérieurs a été de 37%, pour les membres inférieurs de 23% et pour les fonctions sphinctériennes de 17%. La décompression chirurgicale des myélopathies cervicales est une opération intéressante; 71% des patients ont vu une amélioration neurologique après l’intervention. Cette récupération atteint un plateau six mois après l’intervention. La récupération des membres supérieurs est la plus importante, suivie de la récupération des membres inférieurs puis de la récupération sphinctérienne. Mots clés : myélopathie cervicale, récupération neurologique.

     

甲基强的松龙在脊髓型颈椎病围手术期应用的价值

目的:探讨甲基强的松龙(MP)在脊髓型颈椎病(CSM)围手术期应用的价值。方法:2004年1月～2005年1月对18例CSM患者行颈椎前路减压手术,并于围手术期应用MP(治疗组);对照组25例CSM患者仅行前路减压手术。观察两组患者术后一般情况、并发症,并检测术前和术后第1、3、7天的血清白细胞介素-6(IL-6)和C反应蛋白(CRP);采用Odom′s评分标准评估患者术后6个月时神经功能恢复情况。结果:术后3d内MP治疗组患者体温、基础代谢率增幅明显低于对照组(P<0.05),血清IL-6和CRP与对照组比较也显著降低(P<0.05);术后第7天血清IL-6和CRP两组之间无显著性差异(P>0.05);两组患者并发症情况无显著性差异(P>0.05);术后6个月两组患者神经功能均明显恢复,对照组和MP治疗组优良率分别为76.0%、83.3%,两组之间有显著性差异(P<0.05)。结论:围手术期应用MP能缓解手术应激反应,促进神经功能恢复,进而改善CSM患者的手术疗效。     

脊髓型颈椎病患者的行走功能

目的:研究脊髓型颈椎病(CSM)患者的行走功能及术后近期改善情况。方法:对103例CSM患者进行行走试验,并对病程、起病症状、脊髓功能评分进行分析,观察手术前、后的行走功能改变。结果:病程大于6个月、脊髓功能评分低的患者下肢行走功能差,手术后改善程度较小。起病时无下肢乏力的患者也存在下肢行走功能障碍。结论:下肢行走功能障碍是CSM患者的早期临床表现,手术后近期可获改善。下肢行走功能可作为CSM严重程度的早期评价指标之一。     

Cervical spondylotic myelopathy associated with syringomyelia: A case report

Summary A case of syringomyelia associated with cervical spondylotic myelopathy is presented. A decompressive cervical laminectomy was performed. The patient improved gradually after operation. It is concluded that the choice of surgical treatment in cases with syringomyelia associated with cervical spondylotic myelopathy requires a careful neurological and radiological examination based on the findings of magnetic resonance imaging (MRI) and cine-MRI.     

前路分段减压手术治疗多节段脊髓型颈椎病的疗效分析

目的:探讨前路分段减压手术治疗多节段脊髓型颈椎病的疗效。方法 :对2005年8月至2016年3月收治的多节段脊髓型颈椎病84例患者的临床资料进行回顾性分析,根据手术方式分为对照组和观察组,每组42例。对照组男26例,女16例,年龄(56.87±11.89)岁,病程(7.91±3.71)年,病变节段C3-C636例,C4-C76例。观察组男24例,女18例,年龄(54.58±12.56)岁,病程(8.03±3.52)年,病变节段C3-C634例,C4-C78例。对照组行后路椎管扩大成形术治疗,观察组行前路分段减压法治疗。观察两组患者的手术时间、术中出血量、住院时间、植骨融合时间及并发症发生率;比较两组患者术前和术后3、6、12个月的JOA评分和融合节段Cobb角。结果:观察组的手术时间、术中出血量、住院时间及并发症发生率明显低于对照组(P0.05);观察组的植骨融合时间也明显低于对照组(P0.01);术后3、6、9个月,观察组的JOA评分和融合节段Cobb角均明显高于对照组(P0.01)。结论:前路分段减压法治疗多节段脊髓型颈椎病具有椎体切除少、减压彻底、术后稳定性好、并发症少等优点,可有效促进脊髓功能及椎体稳定性恢复。     

颈椎单开门桥式植骨椎板成形术治疗脊髓型颈椎病

目的:探讨改良单开门桥式植骨椎板扩大成形术治疗脊髓型颈椎病的疗效及其相关影响因素。方法:采用改良单开门手术,C4、C6两处“桥式”植骨椎板扩大成形治疗61例脊髓型颈椎病患者。结果:随访2～8年,平均4.3年。JOA评分由术前的8.4±1.9分提高到随访时的12.4±3.0分(P<0.01)。其中优15例(24.6%),良16例(26.2%),可24例(39.4%),差6例(9.8%)。C3~C7曲度术后平均减少了8.7°(P<0.01)。CT测量骨性椎管面积术后平均增加67mm2(P<0.01)。矢状径术后平均增加4.1mm(P<0.01)。术后JOA评分改善率与术后骨性椎管面积的改善率两者的相关系数r=0.027。结论:改良单开门“桥式”植骨椎板成形术是一种安全和有效的术式;椎管骨性面积的增加是神经功能改善的基础,术后椎管矢状径扩大以4~5mm为宜。     

Surgical approach to cervical spondylotic myelopathy on the basis of radiological patterns of compression: prospective analysis of 129 cases

This is a prospective analysis of 129 patients operated for cervical spondylotic myelopathy (CSM). Paucity of prospective data on surgical management of CSM, especially multilevel CSM (MCM), makes surgical decision making difficult. The objectives of the study were (1) to identify radiological patterns of cord compression (POC), and (2) to propose a surgical protocol based on POC and determine its efficacy. Average follow-up period was 2.8 years. Following POCs were identified: POC I: one or two levels of anterior cord compression. POC II: one or two levels of anterior and posterior compression. POC III: three levels of anterior compression. POC III variant: similar to POC III, associated with significant medical morbidity. POC IV: three or more levels of anterior compression in a developmentally narrow canal or with multiple posterior compressions. POC IV variant: similar to POC IV with one or two levels, being more significant than the others. POC V: three or more levels of compression in a kyphotic spine. Anterior decompression and reconstruction was chosen for POC I, II and III. Posterior decompression was chosen in POC III variant because they had more incidences of preoperative morbidity, in spite of being radiologically similar to POC III. Posterior surgery was also performed for POC IV and IV variant. For POC IV variant a targeted anterior decompression was considered after posterior decompression. The difference in the mJOA score before and after surgery for patients in each POC group was statistically significant. Anterior surgery in MCM had better result (mJOA = 15.9) versus posterior surgery (mJOA = 14.96), the difference being statistically significant. No major graft-related complications occurred in multilevel groups. The better surgical outcome of anterior surgery in MCM may make a significant difference in surgical outcome in younger and fitter patients like those of POC III whose expectations out of surgery are more. Judicious choice of anterior or posterior approach should be made after individualizing each case.