«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

26卷

期数:

2020年05期

页码:

457-461

栏目:

临床医学

出版日期:

2020-09-20

文章信息/Info

Title:

Clinical study on adjacent vertebral segment degeneration after posterior cervical fixation fusion at C3-C7

文章编号:

1006-8147(2020)05-0457-05

作者:

曹仰敬¹; 申庆丰²; 夏英鹏²

（1.天津医科大学研究生院，天津300070；2.天津市人民医院脊柱外科，天津300121）

Author(s):

CAO Yang-jing¹;  SHEN Qing-feng²;  XIA Ying-peng²

（1.Graduate School，Tianjin Medical University, Tianjin 300070, China；2.Department of Spine Surgery, Tianjin Union Medical Center, Tianjin 300121, China）

关键词:

相邻节段退变; 颈椎后路椎板切除减压; 后路固定融合; 脊髓型颈椎病

Keywords:

adjacent segment degeneration; posterior cervical laminectomy decompression; posterior fixation fusion; cervical spondylotic myelopathy

分类号:

R681.5+3

DOI:

-

文献标志码:

A

摘要:

目的：探究脊髓型颈椎病患者施行颈椎后路C3～C7椎板切除减压，后路固定融合术后，在中期内对相邻节段退变的影响。方法：回顾性分析2015年5月—2018年5月在天津市人民医院行颈椎后路 C3～C7椎板切除减压，后路固定融合术后的41例患者。相邻节段退变的评估采取两种方式：（1）为X光影评定，即在X线侧位片上定义X线椎间隙高度丢失与术前相比大于10%；形成肉眼可见的新生骨赘或 者原有骨赘增大；或者出现前纵韧带钙化。（2）为核磁共振（MRI），在MRI T2加权像上采用Miyazaki的颈椎间盘退变分级方法观察相邻节段退变的情况。同时通过颈椎活动度及椎间高度来进行评估。 结果：所有患者均获得满意的X线片随访及MRI随访，时间为12～26个月，平均18个月。符合观察标准的节段共计82个。患者术后3 d椎间高度与术前相比差异无统计学意义（P＞0.05），末次随访与术后3 d椎间高度对比，差异无统计学意义（P＞0.05）。术后3 d与术前X线过伸、过屈位的颈椎活动度相比，颈椎活动度有明显变化，差异有统计学意义（P＜0.05），而末次随访与术后3 d对比，差异没有统 计学意义（P＞0.05）。末次随访时所有患者植骨达到骨性融合，无内固定松动、脱出、断裂发生。患者的上位、下位相邻节段未出现新生骨赘或者骨赘增大的节段、前纵韧带钙化。通过MRI影像学观察 ，末次随访、术后3 d与术前相比上位、下位相邻节段椎间盘信号无明显变化。结论：C3～C7节段行后路椎板切除减压内固定融合术后，在中期患者不会出现相邻节段退变的发生。

Abstract:

Objective: To investigate the effect of posterior cervical laminectomy and decompression, posterior fixation and fusion (C3-C7) on adjacent segment degeneration in patients with cervical spondylotic myelopathy in medium stage. Methods: A retrospective analysis was performed on 41 patients who underwent posterior cervical laminectomy and decompression, posterior fixation and fusion between May 2015 and May 2018 in Tianjin Union Medical Center. Two methods were used to evaluate adjacent segment degeneration. One was X-ray light and shadow evaluation. X-ray clearance height loss was defined on X-ray lateral radiographs, which was more than 10% compared with that before surgery. Formation of new osteophytes visible to the naked eye or enlargement of original osteophytes were observed. Or calcification of the anterior longitudinal ligament was assessed. Another one was MRI. Miyazaki's cervical disc degeneration grading method was used to observe the degeneration of adjacent segments on the T2-weighted MRI. Cervical range of motion and intervertebral height were also assessed. Results: All patients were followed up with satisfactory X-ray and MRI for 12-26 months, with an average of 18 months. A total of 82 segments met the observation criteria. There was no statistically significant difference in intervertebral height between 3 days after operation and preoperative(P＞0.05). And there was no statistically significant difference between the last follow-up and the postoperative 3 days(P＞0.05). There was a significantly different between 3 days after operation and preoperative X-ray of the cervical range of motion in hyperextension and hyperflexion position(P＜0.05). And there was no significantly different between postoperative 3 days and the last follow-up X-ray of the cervical range of motion in hyperextension and hyperflexion position(P＞0.05). At the last follow-up, all the patients were bone grafted to achieve osseous fusion, and no internal fixation looseness, prolapse or fracture occurred. There was no calcification of new osteophytes or enlarged segments of the anterior longitudinal ligament in the upper and lower adjacent segments of the patient.According to the observation of MRI imaging, there was no significant change in the signal of upper and lower adjacent segment intervertebral discs at the last follow-up and 3 days after operation compared with preoperative. Conclusion: Adjacent segment degeneration does not observe after posterior cervical laminectomy decompression and fixation fusion (C3-C7) in medium stage.

参考文献/References:

[1] Traynelis V C, Arnold P M, Fourney D R, et al. Alternative procedures for the treatment of cervical spondylotic myelopathy: arthroplasty, oblique corpectomy, skip laminectomy: evaluation of comparative effectiveness and safety[J]. Spine, 2013, 38(22 Suppl 1):S210
[2] 刘正军,姜康.颈椎后路全椎板减压侧块螺钉内固定术治疗多节段脊髓型颈椎病的疗效[J].中华临床医师杂志（电子版），2015,16 (16):3136
[3] 程真,王林峰,申勇,等.颈椎曲度及椎间高度变化对颈后路减压术后疗效的影响[J].中华骨科杂志, 2012, 32(4): 304
[4] Robertson J T, Papadopoulos S M, Traynelis V C. Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study[J]. J Neurosurg Spine, 2005,3(6):417
[5] Kim S W, Limson M A, Kim S B, et al. Comparison of radiographic changes after ACDF versus bryan disc arthroplasty in single and bi-level cases[J].Eur Spine J,2009,18(2):218
[6] Miyazaki M, Hong S W, Yoon S H, et al. Reliability of a magnetic resonance imaging-based grading system for cervical intervertebral disc degeneration[J]. J Spinal Disord Tech, 2008, 21(4):288
[7] Cauthen J C, Theis R P, Allen A T. Anterior cervical fusion: a comparison of cage, dowel and dowel-plate constructs[J].Spine J, 2003,3(2):106
[8] Hilibrand A S, Carlson G D, Palumbo M A, et al.Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis[J]. J Bone Joint Surg Am,1999,81(4):519
[9] Baba H,Furusawa N,Imura S, et al.Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy[J].Spine, 1993,18(15):2167
[10] Gore D R, Sepic S B. Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients[J]. Spine (Phila Pa 1976), 1984,9(7): 667
[11] Yue W M, Brodner W , Highland T R. Long-term results after anterior cervical discectomy and fusion with allograft and plating:a 5-to 11-year radiologic and clinical follow-up study[J]. Spine(Phila Pa 1976), 2005, 30(19): 2138
[12] Bohlman H H, Emery S E, Goodfellow D B, et al. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients[J]. J Bone Joint Surg Am, 1993, 75(9): 1298
[13] Williams J L, Allen M B Jr, Harkess J W. Late results of cervical discectomy and interbody fusion: some factors influencing the results[J]. J Bone Joint Surg Am, 1968, 50(2): 277
[14] Chung J Y,Kim S K,Jung S T, et al.Clinical adjacent-segment pathology after anterior cervical discectomy and fusion: results after a minimum of 10-year follow-up[J]. Spine J,2014,14(10): 2290
[15] 杨晋才,海涌,裴葆青,等.颈前路融合节段数对上位邻近节段影响的生物力学研究[J].中华外科杂志, 2014, 52(9):692
[16] 张睿,周文钰,顾洪生,等.颈椎单节段融合术后相邻各节段运动补偿的规律研究[J].中国临床实用医学, 2014, 5(1):11
[17] Lee J C, Lee S H, Peters C, et al. Adjacent segment pathology requiring reoperation after anterior cervical arthrodesis: the influence of smoking, sex, and number of operated levels[J]. Spine(Phila Pa 1976), 2015, 40(10): E571
[18] Duan Y, Zhang H, Min S X, et al. Posterior cervical fixation following laminectomy: a stress analysis of three techniques[J]. Eur Spine J, 2011, 20(9):1552
[19] 张振辉,陶志强,伍绍成,等.多节段脊髓型颈椎病前后路手术疗效的临床观察[J].中国骨与关节损伤杂志, 2012, 27(1): 37
[20] Barbarawi M A, Allouh M Z. Cervical lateral mass screw-rod fixation: surgical experience with 2500 consecutive screws, an analytical review,and long-term outcomes[J].Br J Neurosur, 2015, 29(5): 699
[21] Audat Z A, Barbarawi M M, Obeidat M M. Posterior cervical decompressive laminectomy and lateral mass screw fixation[J]. Neuroences, 2011,16(3): 248
[22] 李亮,燕树义,于学忠,等.两种颈后路术式对颈椎曲度及椎间高度的中期影响[J].中国矫形外科杂志, 2013,21(19): 1929
[23] Kotil K, Sengoz A. The management in the C2-C3 disc herniations: a clinical study[J].Turk Neurosurg, 2011,21(1):15
[24] 王洪立，姜建元，吕飞舟，等. 颈椎前路融合术后邻近节段退变性疾病的原因分析及治疗策略[J]. 中华骨科杂志, 2014, 34(9): 915
[25] Park M S, Kelly M P, Lee D H, et al. Sagittal alignment as a predictor of clinical adjacent segment pathology requiring surgery after anterior cervical arthrodesis[J]. Spine J, 2014,14(7):1228
[26] 邓志龙,张晓星,王令,等.颈椎前路减压植骨融合术后邻近节段退变情况分析[J].创伤外科杂志,2011,13(6): 507
[27] Lee S E, Jahng T A, Kim H J. Correlation between cervical lordosis and adjacent segment pathology after anterior cervical spinal surgery[J].Eur Spine J, 2015,24(12):2899
[28] Faldini C,Pagkrati S,Leonetti D, et al.Sagittal segmental alignment as predictor of adjacent-level degeneration after a cloward procedure[J].Clin Orthop Relat Res,2011, 469(3): 674

相似文献/References:

备注/Memo

备注/Memo:

作者简介 曹仰敬（1993-），男，硕士在读，研究方向：脊柱外科；
通信作者：夏英鹏，E-mail：xiayingpeng3755@163.com。

常用功能

更新日期/Last Update: 2020-09-18