退变性颈椎不稳的回顾性调查与临床研究

目的 :探讨退变性颈椎不稳的定义、诊断标准和治疗原则 ,分析其外科手术的远期疗效和影响因素 ,了解颈椎手术和颈椎稳定性之间的相关性。　方法 :对 10 3例退变性颈椎疾病患者进行回顾性调查 ,包括收集完整的病案资料 ,进行影像学测量和随访。　结果 :无论采用何种手术入路 ,术后手术疗效评价 (JOA)评分均比术前有显著提高 (P <0 .0 1) ;前路手术对脊神经功能的改善效果明显优于后路手术 (P <0 .0 1) ;融合笼植入术维持手术节段术后椎间隙高度的效果明显优于自体髂骨植入 (P <0 .0 1) ;就恢复颈椎生理弧度的效果而言 ,融合笼植入术亦优于自体髂骨植入 (P <0 .0 5 ) ;关于手术对颈椎不稳的改善效果 ,前入路组优于后入路组 (P <0 .0 5 ) ,使用椎间融合器组好于未使用组 (P <0 .0 5 )。　结论 :退变性颈椎不稳并不是单独存在的疾病 ,而是缓慢进行性发展的力学状态改变 ,常和脊髓型颈椎病伴随发生 ,并对后者的进展起推波助澜的作用 ,提高临床医师的警惕性 ,密切结合临床症状、体征和影像学检查 ,才能做到早期发现、早期处理 ,从而改善患者的预后

Retrospective study and clinical research of degenerative cervical instability

Objectves:To explore the definition, diagnosis criterions and treating principles of degenerative cervical instability, to analyze the long term results of surgical intervention and its influencing factors, to investigate the correlation between cervical operation and cervical stability. Methods:One hundred and three patients with degenerative cervical diseases treated by surgical intervention were investigated according to the case records, radiographic measurements and the follow up results. Results:The JOA score increased significantly by every pattern of operation( P <0.01).Anterior decompression seemed more effective in improving spinal and neural functions than posterior decompression( P <0.01).Fusion cage appeared more effective than iliac crest graft in maintaining the intervertebral height( P < 0.01 ) and regaining the cervical curvature( P <0.05).Concerning the aspect of improving cervical stability, anterior decompression seemed better than posterior method( P <0.05) and fusion cage was better than iliac crest graft( P <0.05). Conclusions:Degenerative cervical instability is not an independent disease,but a progressive mechanical status which often accompanies with cervical spondylotic myelopathy(CSM).Degenerative cervical instability is a definitive cause of CSM, so that earlier diagnosis and earlier treatment become more valuable and beneficial to such patients.Doctors should have high vigilance and combine the symptoms,physical signs and radiographic manifestations together to establish a whole impress.