| 颈后路减压术后效果不佳原因分析及防治体会 |
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投稿时间：2016-06-07
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| 作者 | Author | 单位 | Address | E-Mail |
| 秦德安 |
QIN De-an |
北京大学第三医院骨科, 北京 100191
山西省人民医院骨科, 山西 太原 030012 |
Department of Orthopaedics, the Third Hospital of Peking University, Beijing 100191, China |
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| 刘晓光 |
LIU Xiao-guang |
北京大学第三医院骨科, 北京 100191 |
Department of Orthopaedics, the Third Hospital of Peking University, Beijing 100191, China |
xglius@vip.sina.com.cn |
| 吴奉梁 |
WU Feng-liang |
北京大学第三医院骨科, 北京 100191 |
Department of Orthopaedics, the Third Hospital of Peking University, Beijing 100191, China |
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| 刘忠军 |
LIU Zhong-jun |
北京大学第三医院骨科, 北京 100191 |
Department of Orthopaedics, the Third Hospital of Peking University, Beijing 100191, China |
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| 张凤山 |
ZHANG Feng-shan |
北京大学第三医院骨科, 北京 100191 |
Department of Orthopaedics, the Third Hospital of Peking University, Beijing 100191, China |
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| 孙宇 |
SUN Yu |
北京大学第三医院骨科, 北京 100191 |
Department of Orthopaedics, the Third Hospital of Peking University, Beijing 100191, China |
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| 期刊信息：《中国骨伤》2017年，第30卷，第2期，第163-168页 |
| DOI：10.3969/j.issn.1003-0034.2017.02.014 |
| 基金项目: |
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中文摘要:
目的：探讨颈后路减压术后效果不佳的原因、翻修策略和预防措施。
方法：回顾性分析2012年1月至2014年12月收治的行颈后路减压术后因各种原因导致的疗效不佳而行翻修手术者14例，分析其翻修原因并针对性采用不同的翻修术式，初次术前、翻修术前和末次随访时采用改良JOA 17分法评定脊髓神经功能，采用Nurick分级评价行走功能。计算初次手术前后和翻修前后神经功能改善率。采用SPSS 16.0统计软件对上述数据进行统计分析。
结果：再手术原因包括：椎板切除减压宽度不够2例，单开门纵向减压节段不够2例，门轴侧骨折塌陷压迫神经根和脊髓2例，椎板再关门4例，开门角度过小1例，后纵韧带骨化进展2例（其中1例伴关门），颈椎后凸畸形加重2例（其中1例伴关门），钩椎关节增生致神经根管狭窄1例。初次术前、翻修前和末次随访时改良JOA评分分别是11.89±1.67，13.11±1.09和15.61±0.59，Nurick分级分别是4.21±0.58，3.57±0.51和1.71±0.47。末次随访时与初次术前、翻修前比较差异均有统计学意义（P<0.05）。初次手术前后和翻修前后神经功能改善率分别为差（22.33±9.49）%和良（64.60±9.88）%，两者比较差异有统计学意义（P<0.05）。
结论：针对颈后路减压术后效果不佳的各种原因采用个体化原则进行翻修，可进一步改善脊髓功能，术前仔细分析致病因素，术中减压彻底，降低翻修率。 |
| 【关键词】颈后路减压 翻修 治疗失败 |
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| Etiological analysis,preventional and therapeutical strategies for the unsatisfied cervical posterior decompression surgery |
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ABSTRACT
Objective: To discuss the causes of unsatisfied cervical posterior decompression surgery and describe the overhauling strategies and precaution.
Methods: The clinical data of 14 patients required revision surgery were retrospectively analyzed,and these patients with unsatisfied effects were due to cervical posterior decompression surgery from January 2012 to December 2014. Overhauling reasons were analyzed and then different revision procedures were performed. The functions of cervical cord and ambulation were evaluated respectively by modified Japanese Orthopedic Association(mJOA) score and Nurick grade according to the course order:preoperative for the first time,pre-revision and at final follow-up. Improvement rate of nerves function were calculated before and after operation for the first time,before and after revision. Above data were statistically analyzed by SPSS16.0 software.
Results: Reoperation reasons including 2 patients with the insufficiency width of laminectomy,2 patients with the inadequate length of decompression,2 patients with nerve root and spinal cord compression caused by fractured collapse,4 patients with closed the door of vertebral lamina,1 patient with less open-door angle,2 patiens with ossification of posterior longitudinal ligament (1 case complicated with close the door),2 patients with cervical spine kyphotic deformity aggravating (1 case complicated with close the door),1 patient with nerve root canal stenosis caused by uncovertebral joint hyperplasia. Preoperative for the first time,pre-revision and at final follow-up,mJOA scores were 11.89±1.67,13.11±1.09,15.61±0.59,and Nurick grades were 4.21±0.58,3.57±0.51,1.71±0.47,respectively. There was significant difference between final follow-up and preoperative for the first time,pre-revision(P<0.05). Improvement rate of nerve function was (22.33±9.49)% with bad before and after operation for the first time,and (64.60±9.88)% with good before and after revision,with statistical significance(P<0.05).
Conclusion: Individualized revision surgery based on different causes for unsatisfied cervical posterior decompression can improve the function of spinal cord. Preoperative carefully analyzing the etiological factors,thoroughly decompression can reduce the revision rate. |
| KEY WORDS Cervical posterior decompression Revision Treatment failure |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 秦德安,刘晓光,吴奉梁,刘忠军,张凤山,孙宇.颈后路减压术后效果不佳原因分析及防治体会[J].中国骨伤,2017,30(2):163~168 |
| 英文格式: | QIN De-an,LIU Xiao-guang,WU Feng-liang,LIU Zhong-jun,ZHANG Feng-shan,SUN Yu.Etiological analysis,preventional and therapeutical strategies for the unsatisfied cervical posterior decompression surgery[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(2):163~168 |
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