Objective：To investigate a novel surgical method for multilevel cervical spondylotic myelopathy （CSM）. Methods： Totally 21 patients with multilevel CSM undergoing a novel surgical procedure from April 2001 to Janu...Objective：To investigate a novel surgical method for multilevel cervical spondylotic myelopathy （CSM）. Methods： Totally 21 patients with multilevel CSM undergoing a novel surgical procedure from April 2001 to January 2004 were analyzed retrospectively. All patients experienced anterior cervical decompression surgery in subsection, autograft fusion and internal fixation. Preoperative, immediate postoperative and follow-up image data, X-rays and semi-quantitative Japanese orthopaedics association （JOA） scores were used to evaluate the restoration of lordosis （Cobb＇s angle）, intervertebral heights, the stability of the cervical spine and the improvement of neurological impairment. Results： Preoperative symptoms were markedly alleviated or disappeared in most of the patients. According to the JOA scores, the ratio of improvement in neurological function was 72. 2%, including excellent in 9 cases （42.9%）, good in 7 cases （33.3%）, fair in 3 cases （14.3%） and poor in 2 cases （9.5%）. Immediate postoperative X-rays showed obvious improvements in lordosis and in the intervertebral height of the cervical spine （P〈0. 01）. There is no evidence of instrument failure during the mean follow-up period of 14. 2 months （9-24 months, P〉0. 01）. Conclusion：Anterior cervical decompression in subsection, autograft fusion and internal fixation is a rational effective method for the surgical treatment of multilevel CSM.展开更多
BACKGROUND Spinal deformities in Ehlers-Danlos syndrome(EDS; type VI) are generally progressive and severe. Surgical treatment has been described for kyphoscoliosis in the thoracolumbar spine. However, there are few s...BACKGROUND Spinal deformities in Ehlers-Danlos syndrome(EDS; type VI) are generally progressive and severe. Surgical treatment has been described for kyphoscoliosis in the thoracolumbar spine. However, there are few studies describing the consequences of an anterior approach in cervical kyphosis. An anterior approach may not be able to fully decompress the spinal canal and restore the normal curvature of the cervical spine. Therefore, the anterior approach for cervical kyphosis in young children is hard. We describe the first case in an EDS girl with cervical kyphosis who received satisfactory anterior cervical corpectomy decompression and fusion.CASE SUMMARY The chief complaints of a 16-year-old girl with EDS were double upper limb weakness for 7 years and double lower limb walking instability for 2 years.Moreover, the imaging results revealed that the degree of kyphosis from cervical vertebra 2 to 4 accompanying with spinal cord compression was 30°. An anterior cervical corpectomy involving cervical vertebra 3 and a titanium mesh implant were performed with internal fixation. The results at 3 mo after surgery demonstrated that the anterior fusion was solid, and the kyphosis of the cervical spine was corrected. Additionally, the power of all four extremities was significantly improved.CONCLUSION The incidence rate of cervical kyphosis in EDS is rare. The surgical treatment for these patients, especially an anterior approach, is challenging. Therefore, to develop safer and more effective strategies to treat cervical kyphosis in EDS,there is still much work to do.展开更多
Anterior cervical decompression and fusion(ACDF)treatment for cervical spondylosis has been more than half a century,and achieved good clinical results.However,with the continuous extension of follow-up time,the fusio...Anterior cervical decompression and fusion(ACDF)treatment for cervical spondylosis has been more than half a century,and achieved good clinical results.However,with the continuous extension of follow-up time,the fusion segment-associated postoperative complications emerged gradually.Reserved cervical stability and activity,the concept of non-fusion was born.As a non-fusion technique,cervical artificial disc replacement(CADR)developed rapidly.With the continuous development of artificial prosthesis materials and design concepts,and specification and proficiency of surgical procedures,CADR has achieved better short and mid-term clinical efficacy than ACDF.Compared with ACDF,the main advantages of CADR are that the postoperative recovery is quick,the activity and stability of cervical vertebra are maintained,the height of cervical intervertebral space is restored,and the stress of adjacent segments and the rate of surgical renovation are reduced.In clinical work,as an emerging technology,CADR requires spine surgeons to control the surgical indications,contraindications,and patients'conditions strictly.This article reviews the research progress of CADR in order to provide new ideas for clinical treatment of cervical spondylosis.展开更多
目的:颈前路减压融合术是治疗退行性颈椎病的经典手术方式,钉板的使用增加了融合率及稳定性的同时,间接导致了邻近椎体退变和术后吞咽困难的发生。文章通过Meta分析方法比较ROI-C^(TM)自锁系统和传统融合器联合钉板内固定治疗退行性颈...目的:颈前路减压融合术是治疗退行性颈椎病的经典手术方式,钉板的使用增加了融合率及稳定性的同时,间接导致了邻近椎体退变和术后吞咽困难的发生。文章通过Meta分析方法比较ROI-C^(TM)自锁系统和传统融合器联合钉板内固定治疗退行性颈椎病患者的临床结果和并发症情况,为颈前路减压融合术中内固定方式的选择提供循证学支持。方法:检索中国知网、万方、维普、PubMed、Cochrane Library、Web of Science和Embase数据库,检索关于颈前路减压融合术中应用ROI-C^(TM)自锁系统与融合器联合钉板内固定治疗退行性颈椎病的中英文文献。检索时间范围为各数据库建库至2023年7月。由2名研究者严格按照纳入与排除标准选择文献,采用Cochrane偏倚风险工具对随机对照试验进行质量评价,NOS量表对队列研究进行质量评价。采用RevMan 5.4软件进行Meta分析。结局指标包括手术时间、术中出血量、日本骨科协会(Japanese Orthopaedic Association Scores,JOA)评分、颈椎功能障碍指数、C_(2)-C_(7)Cobb角、融合率、邻近椎体退变发生率、融合器沉降率和吞咽困难发生率。结果:共纳入13项研究,其中回顾性队列研究11项,随机对照试验2项,共1136例患者,ROI-C组569例,融合器联合钉板组567例。Meta分析结果显示:ROI-C组与融合器联合钉板组在手术时间(MD=-15.52,95%CI:-18.62至-12.42,P<0.00001),术中出血量(MD=-24.53,95%CI:-32.46至-16.61,P<0.00001),术后邻近节段退变率(RR=0.40,95%CI:0.27-0.60,P<0.00001)和术后总吞咽困难发生率(RR=0.18,95%CI:0.13-0.26,P<0.00001)均具有显著性差异。两者在术后JOA评分、颈椎功能障碍指数、C_(2)-C_(7)Cobb角、融合率和融合器沉降率方面无显著性差异(P≥0.05)。结论:在颈椎前路减压融合术中应用ROI-C^(TM)自锁系统与传统融合器联合钉板内固定治疗退行性颈椎病均可达到满意的临床效果,ROI-C^(TM)自锁系统操作更加简单,相比融合器联合钉板内固定能明显减少手术时间及术中出血量,在减少术后吞咽困难及邻近节段退变发生率等方面具有明显优势,对于跳跃型颈椎病及邻椎病翻修患者,更加推荐使用ROI-C^(TM)自锁系统。但鉴于其可能存在较高的沉降率,对于多节段且合并融合器沉降高危因素如骨质疏松、椎体终板破损的退行性颈椎病患者,仍建议使用融合器联合钉板内固定。展开更多
目的比较颈前路椎间盘切除融合(anterior cervical discectomy with fusion,ACDF)术与颈前路椎体次全切减压融合(anterior cervical corpectomy with fusion,ACCF)术治疗相邻两节段脊髓型颈椎病患者的临床疗效。方法选取2019年8月至2022...目的比较颈前路椎间盘切除融合(anterior cervical discectomy with fusion,ACDF)术与颈前路椎体次全切减压融合(anterior cervical corpectomy with fusion,ACCF)术治疗相邻两节段脊髓型颈椎病患者的临床疗效。方法选取2019年8月至2022年8月西藏军区总医院收治的70例相邻两节段脊髓型颈椎病患者作为研究对象,按照不同手术方式分为甲组与乙组,每组35例。甲组采取ACDF术治疗,乙组采取ACCF术治疗,比较两组手术相关指标、颈椎融合节段Cobb角和颈椎曲度、术后并发症发生情况、颈椎日本骨科协会(Japanese Orthopedic Association,JOA)评分。结果甲组手术时间长于乙组,术中出血量少于乙组,差异有统计学意义(P<0.05);术后12个月,两组颈椎融合节段Cobb角、颈椎曲度均大于术前,且甲组大于乙组,差异有统计学意义(P<0.05);两组术后并发症发生率比较差异无统计学意义;术后6个月,两组颈椎JOA评分均高于术前,差异有统计学意义(P<0.05),但两组间比较差异无统计学意义。结论ACDF、ACCF术治疗相邻两节段脊髓型颈椎病的安全性及术后颈椎功能恢复效果相当,但ACDF术可明显改善患者颈椎融合节段Cobb角、颈椎曲度,减少术中出血量,而ACCF术手术时间更短,临床可酌情选择术式。展开更多
目的探究显微镜辅助颈椎前路减压内固定融合术(anterior cervical decompression and fusion,ACDF)在颈椎病治疗中的效果。方法回顾性分析烟台业达医院2019年2月~2020年6月收治的78例颈椎病患者资料,按手术方式的不同分成A、B组。A组38...目的探究显微镜辅助颈椎前路减压内固定融合术(anterior cervical decompression and fusion,ACDF)在颈椎病治疗中的效果。方法回顾性分析烟台业达医院2019年2月~2020年6月收治的78例颈椎病患者资料,按手术方式的不同分成A、B组。A组38例实施标准开放ACDF治疗,B组40例实施显微镜辅助ACDF。观察并记录两组手术参数,统计并发症发生情况,采用数字分级评分法(numerical rating scale,NRS)、日本骨科协会评分(Japanese orthopaedic association score,JOA)分别对两组术前、术后1年的疼痛度、颈椎神经功能进行评定,测量颈椎Cobb角,并计算颈椎神经功能改善率。结果B组手术用时、术中失血量均较A组少(P<0.05),术后住院时间组间比较无统计学差异(P>0.05);A组发生2例脑脊液漏,B组无并发症发生,组间比较无统计学差异(P>0.05);与同组术前相比,两组术后1年NRS、JOA评分、颈椎Cobb角均明显改善(P<0.05),而组间上述指标比较均无统计学差异(P>0.05);A组颈椎神经功能改善率89.47%与B组的92.50%相比,无统计学差异(P>0.05)。结论对颈椎病患者实施显微镜辅助ACDF的治疗效果较好,且具有手术用时短、术中失血量少等优势。展开更多
目的:将以钩椎关节拐点为辅助定位标记点的颈椎前路经椎间隙截骨融合术(anterior intervertebral osteotomy and fusion,AIOF)与颈椎前路椎体次全切融合术(anterior cervical corpectomy and fusion,ACCF)治疗伴椎间隙狭窄颈椎病的临床...目的:将以钩椎关节拐点为辅助定位标记点的颈椎前路经椎间隙截骨融合术(anterior intervertebral osteotomy and fusion,AIOF)与颈椎前路椎体次全切融合术(anterior cervical corpectomy and fusion,ACCF)治疗伴椎间隙狭窄颈椎病的临床效果进行对比。方法:回顾性分析2016年6月~2021年6月于中国人民解放军中部战区总医院脊柱外科行手术治疗的80例伴椎间隙狭窄颈椎病患者,根据手术方式分为AIOF组与ACCF组。AIOF组38例,年龄51.2±16.3岁,随访时间为21.2±7.2个月;ACCF组42例,年龄54.0±13.2岁,随访时间为24.3±8.1个月,两组患者的年龄、性别、随访时间、手术节段等术前一般资料无统计学差异(P>0.05)。通过比较两组患者的手术时间、术中出血量分析患者的围术期情况;通过两组患者术前、术后1周、术后3个月、6个月以及末次随访时患者的日本骨科协会评分(Japanese Orthopaedic Association,JOA)、颈部视疼痛觉模拟评分(visual analogue scale,VAS)的差异评估患者的手术疗效;分别在术前、术后3个月、术后6个月以及末次随访时通过X线、CT以及MRI测量脊髓直径、椎管面积、椎间孔面积、颈椎前凸角、颈椎活动度(range of motion,ROM);记录患者术后并发症的发生率以及植骨融合情况。结果:所有患者手术顺利,AIOF组手术时间106.1±35.4min,术中出血量50.6±12.3mL;ACCF组手术时间121.4±42.3min,术中出血量150.3±37.7mL,两组手术时间无统计学差异(P>0.05),但AIOF组患者术中出血量少于ACCF组(P<0.05)。两组患者术后各时间点JOA评分与VAS评分均较术前有明显改善(P<0.05)。末次随访时AIOF组JOA评分改善率为(72.3±10.4)%,VAS评分为0.8±0.6分;ACCF组JOA评分改善率为(63.7±12.1)%,VAS评分为1.2±0.7分,术后各时间点两组间比较均有统计学差异(P<0.05)。末次随访时AIOF组患者的脊髓直径、椎管面积和颈椎ROM分别为5.4±1.1mm、128.2±10.1mm2、25.3°±6.3°,ACCF组分别为5.2±0.7mm、126±12.0mm2、24.2°±4.4°,两组比较均无统计学差异(P>0.05);两组椎间孔面积与颈椎前凸角(AIOF组49.7±8.8mm2、14.8°±4.8°vs ACCF组35.9±7.6mm2、6.7°±4.8°)均有统计学差异(P<0.05)。术后AIOF组1例患者出现吞咽困难;ACCF组中有1例脑脊液漏、2例C5神经根麻痹、1例吞咽困难、2例融合失败,两组患者术后并发症的发生率有统计学差异(P<0.05)。结论:对伴有颈椎间隙狭窄的颈椎病患者,AIOF在钩椎关节拐点辅助定位下比ACCF更安全地实现椎管内及椎间孔的减压,重建颈椎曲度,具有创伤小、并发症发生率低、椎间孔减压充分以及术后颈椎曲度改善更好的优势。展开更多
目的:分析并比较颈椎前路椎间盘切除减压融合术(anterior cervical discectomy and fusion,ACDF)、颈椎前路椎体次全切除减压融合术(anterior cervical corpectomy and fusion,ACCF)在双节段颈椎病的应用效果。方法:选择2020年12月—202...目的:分析并比较颈椎前路椎间盘切除减压融合术(anterior cervical discectomy and fusion,ACDF)、颈椎前路椎体次全切除减压融合术(anterior cervical corpectomy and fusion,ACCF)在双节段颈椎病的应用效果。方法:选择2020年12月—2023年12月淮安八十二医院接收的90例双节段颈椎病患者,利用最新统计学软件生成随机序列后分为对照组、观察组,各45例。对照组予以ACCF治疗,观察组予以ACDF治疗。对比两组围手术期指标、疼痛缓解情况、颈椎功能恢复情况及不良事件发生情况。结果:观察组围手术期指标(手术时间、术中出血量、术后引流量、下床时间及住院时间)均优于对照组,差异均有统计学意义(P<0.05)。治疗前、治疗后14 d及1、2个月,两组数字评分法(numeric rating scales,NRS)评分比较,差异均无统计学意义(P>0.05)。治疗前及治疗后1、2个月,两组关节活动度(range of motion,ROM)、最狭窄处脊髓面积、颈椎生理曲线、椎管横截面积比较,差异均无统计学意义(P>0.05)。两组不良事件总发生率比较,差异无统计学意义(P>0.05)。结论:ACDF、ACCF治疗双节段颈椎病的效果不存在明显差异,但ACDF手术时间较短,且出血量较少,更适用于对手术耐受度较低的患者。展开更多
文摘Objective：To investigate a novel surgical method for multilevel cervical spondylotic myelopathy （CSM）. Methods： Totally 21 patients with multilevel CSM undergoing a novel surgical procedure from April 2001 to January 2004 were analyzed retrospectively. All patients experienced anterior cervical decompression surgery in subsection, autograft fusion and internal fixation. Preoperative, immediate postoperative and follow-up image data, X-rays and semi-quantitative Japanese orthopaedics association （JOA） scores were used to evaluate the restoration of lordosis （Cobb＇s angle）, intervertebral heights, the stability of the cervical spine and the improvement of neurological impairment. Results： Preoperative symptoms were markedly alleviated or disappeared in most of the patients. According to the JOA scores, the ratio of improvement in neurological function was 72. 2%, including excellent in 9 cases （42.9%）, good in 7 cases （33.3%）, fair in 3 cases （14.3%） and poor in 2 cases （9.5%）. Immediate postoperative X-rays showed obvious improvements in lordosis and in the intervertebral height of the cervical spine （P〈0. 01）. There is no evidence of instrument failure during the mean follow-up period of 14. 2 months （9-24 months, P〉0. 01）. Conclusion：Anterior cervical decompression in subsection, autograft fusion and internal fixation is a rational effective method for the surgical treatment of multilevel CSM.
文摘BACKGROUND Spinal deformities in Ehlers-Danlos syndrome(EDS; type VI) are generally progressive and severe. Surgical treatment has been described for kyphoscoliosis in the thoracolumbar spine. However, there are few studies describing the consequences of an anterior approach in cervical kyphosis. An anterior approach may not be able to fully decompress the spinal canal and restore the normal curvature of the cervical spine. Therefore, the anterior approach for cervical kyphosis in young children is hard. We describe the first case in an EDS girl with cervical kyphosis who received satisfactory anterior cervical corpectomy decompression and fusion.CASE SUMMARY The chief complaints of a 16-year-old girl with EDS were double upper limb weakness for 7 years and double lower limb walking instability for 2 years.Moreover, the imaging results revealed that the degree of kyphosis from cervical vertebra 2 to 4 accompanying with spinal cord compression was 30°. An anterior cervical corpectomy involving cervical vertebra 3 and a titanium mesh implant were performed with internal fixation. The results at 3 mo after surgery demonstrated that the anterior fusion was solid, and the kyphosis of the cervical spine was corrected. Additionally, the power of all four extremities was significantly improved.CONCLUSION The incidence rate of cervical kyphosis in EDS is rare. The surgical treatment for these patients, especially an anterior approach, is challenging. Therefore, to develop safer and more effective strategies to treat cervical kyphosis in EDS,there is still much work to do.
文摘Anterior cervical decompression and fusion(ACDF)treatment for cervical spondylosis has been more than half a century,and achieved good clinical results.However,with the continuous extension of follow-up time,the fusion segment-associated postoperative complications emerged gradually.Reserved cervical stability and activity,the concept of non-fusion was born.As a non-fusion technique,cervical artificial disc replacement(CADR)developed rapidly.With the continuous development of artificial prosthesis materials and design concepts,and specification and proficiency of surgical procedures,CADR has achieved better short and mid-term clinical efficacy than ACDF.Compared with ACDF,the main advantages of CADR are that the postoperative recovery is quick,the activity and stability of cervical vertebra are maintained,the height of cervical intervertebral space is restored,and the stress of adjacent segments and the rate of surgical renovation are reduced.In clinical work,as an emerging technology,CADR requires spine surgeons to control the surgical indications,contraindications,and patients'conditions strictly.This article reviews the research progress of CADR in order to provide new ideas for clinical treatment of cervical spondylosis.
文摘目的:颈前路减压融合术是治疗退行性颈椎病的经典手术方式,钉板的使用增加了融合率及稳定性的同时,间接导致了邻近椎体退变和术后吞咽困难的发生。文章通过Meta分析方法比较ROI-C^(TM)自锁系统和传统融合器联合钉板内固定治疗退行性颈椎病患者的临床结果和并发症情况,为颈前路减压融合术中内固定方式的选择提供循证学支持。方法:检索中国知网、万方、维普、PubMed、Cochrane Library、Web of Science和Embase数据库,检索关于颈前路减压融合术中应用ROI-C^(TM)自锁系统与融合器联合钉板内固定治疗退行性颈椎病的中英文文献。检索时间范围为各数据库建库至2023年7月。由2名研究者严格按照纳入与排除标准选择文献,采用Cochrane偏倚风险工具对随机对照试验进行质量评价,NOS量表对队列研究进行质量评价。采用RevMan 5.4软件进行Meta分析。结局指标包括手术时间、术中出血量、日本骨科协会(Japanese Orthopaedic Association Scores,JOA)评分、颈椎功能障碍指数、C_(2)-C_(7)Cobb角、融合率、邻近椎体退变发生率、融合器沉降率和吞咽困难发生率。结果:共纳入13项研究,其中回顾性队列研究11项,随机对照试验2项,共1136例患者,ROI-C组569例,融合器联合钉板组567例。Meta分析结果显示:ROI-C组与融合器联合钉板组在手术时间(MD=-15.52,95%CI:-18.62至-12.42,P<0.00001),术中出血量(MD=-24.53,95%CI:-32.46至-16.61,P<0.00001),术后邻近节段退变率(RR=0.40,95%CI:0.27-0.60,P<0.00001)和术后总吞咽困难发生率(RR=0.18,95%CI:0.13-0.26,P<0.00001)均具有显著性差异。两者在术后JOA评分、颈椎功能障碍指数、C_(2)-C_(7)Cobb角、融合率和融合器沉降率方面无显著性差异(P≥0.05)。结论:在颈椎前路减压融合术中应用ROI-C^(TM)自锁系统与传统融合器联合钉板内固定治疗退行性颈椎病均可达到满意的临床效果,ROI-C^(TM)自锁系统操作更加简单,相比融合器联合钉板内固定能明显减少手术时间及术中出血量,在减少术后吞咽困难及邻近节段退变发生率等方面具有明显优势,对于跳跃型颈椎病及邻椎病翻修患者,更加推荐使用ROI-C^(TM)自锁系统。但鉴于其可能存在较高的沉降率,对于多节段且合并融合器沉降高危因素如骨质疏松、椎体终板破损的退行性颈椎病患者,仍建议使用融合器联合钉板内固定。
文摘目的探究显微镜辅助颈椎前路减压内固定融合术(anterior cervical decompression and fusion,ACDF)在颈椎病治疗中的效果。方法回顾性分析烟台业达医院2019年2月~2020年6月收治的78例颈椎病患者资料,按手术方式的不同分成A、B组。A组38例实施标准开放ACDF治疗,B组40例实施显微镜辅助ACDF。观察并记录两组手术参数,统计并发症发生情况,采用数字分级评分法(numerical rating scale,NRS)、日本骨科协会评分(Japanese orthopaedic association score,JOA)分别对两组术前、术后1年的疼痛度、颈椎神经功能进行评定,测量颈椎Cobb角,并计算颈椎神经功能改善率。结果B组手术用时、术中失血量均较A组少(P<0.05),术后住院时间组间比较无统计学差异(P>0.05);A组发生2例脑脊液漏,B组无并发症发生,组间比较无统计学差异(P>0.05);与同组术前相比,两组术后1年NRS、JOA评分、颈椎Cobb角均明显改善(P<0.05),而组间上述指标比较均无统计学差异(P>0.05);A组颈椎神经功能改善率89.47%与B组的92.50%相比,无统计学差异(P>0.05)。结论对颈椎病患者实施显微镜辅助ACDF的治疗效果较好,且具有手术用时短、术中失血量少等优势。
文摘目的:分析并比较颈椎前路椎间盘切除减压融合术(anterior cervical discectomy and fusion,ACDF)、颈椎前路椎体次全切除减压融合术(anterior cervical corpectomy and fusion,ACCF)在双节段颈椎病的应用效果。方法:选择2020年12月—2023年12月淮安八十二医院接收的90例双节段颈椎病患者,利用最新统计学软件生成随机序列后分为对照组、观察组,各45例。对照组予以ACCF治疗,观察组予以ACDF治疗。对比两组围手术期指标、疼痛缓解情况、颈椎功能恢复情况及不良事件发生情况。结果:观察组围手术期指标(手术时间、术中出血量、术后引流量、下床时间及住院时间)均优于对照组,差异均有统计学意义(P<0.05)。治疗前、治疗后14 d及1、2个月,两组数字评分法(numeric rating scales,NRS)评分比较,差异均无统计学意义(P>0.05)。治疗前及治疗后1、2个月,两组关节活动度(range of motion,ROM)、最狭窄处脊髓面积、颈椎生理曲线、椎管横截面积比较,差异均无统计学意义(P>0.05)。两组不良事件总发生率比较,差异无统计学意义(P>0.05)。结论:ACDF、ACCF治疗双节段颈椎病的效果不存在明显差异,但ACDF手术时间较短,且出血量较少,更适用于对手术耐受度较低的患者。
