吉林大学学报(医学版) ›› 2018, Vol. 44 ›› Issue (01): 131-136.doi: 10.13481/j.1671-587x.20180125

• 临床研究 • 上一篇    下一篇

间盘切除前椎间隙撑开在颈椎前路手术中的应用

孙烁, 庄新明, 汪振宇, 曲志刚, 宋清旭, 张琪, 刘一   

  1. 吉林大学第一医院脊柱外二科, 吉林 长春 130021
  • 收稿日期:2017-09-05 出版日期:2018-01-28 发布日期:2018-01-24
  • 通讯作者: 刘一,教授,博士研究生导师(Tel:0431-88785377,E-mail:liuyi2015310@163.com) E-mail:liuyi2015310@163.com
  • 作者简介:孙烁(1992-),男,山东省日照市人,在读医学硕士,主要从事脊柱外科颈椎病临床治疗方面的研究。
  • 基金资助:
    国家自然科学基金资助课题(31300778)

Application of distraction before discectomy in anterior cervical surgery

SUN Shuo, ZHUANG Xinming, WANG Zhenyu, QU Zhigang, SONG Qingxu, ZHANG Qi, LIU Yi   

  1. Second Department of Spine Surgery, First Hospital, Jilin University, Changchun 130021, China
  • Received:2017-09-05 Online:2018-01-28 Published:2018-01-24

摘要: 目的:观察间盘切除前椎间隙撑开(DBD)操作对颈椎间隙高度的撑开效果,探讨限制过度撑开的可行性。方法:31例患者因脊髓型颈椎病行颈椎前路间盘切除植骨融合内固定术(ACDF)。术中均采用DBD撑开病变椎间隙。术前测量病变椎间隙上端椎体下终板弧顶最高点至下端椎体上终板中点连线的距离(H0),同法测量其相邻近和远端椎间隙的高度(Hp和Hd)。以Hp和Hd的平均值H作为病变椎间隙预期恢复高度的参考值。术中用上述方法测量DBD后病变椎间隙高度(H1)和间盘切除后的病变椎间隙高度(H2)。术后分别测量手术前、后病变节段高度AB和A'B'。手术前后病变节段高度变化值ΔH=A'B'-AB,术后病变椎间隙高度H3=H0+ΔH。根据术后颈肩痛视觉模拟评分法(VAS)评分将患者分为有颈肩痛组和无颈肩痛组。对2组患者影像学测量结果进行统计学分析和比较。结果:ACDF术后颈肩痛发生率为19.35%。术中采用DBD撑开后,病变椎间隙高度变化值ΔH1为(1.19±0.51) mm。无颈肩痛组患者H1[(6.95±0.84) mm]与H[(6.98±0.70) mm]比较差异无统计学意义(P=0.80),H2[(7.31±0.90) mm]与H1[(6.95±0.84) mm]比较差异有统计学意义(P<0.01);有颈肩痛组患者H2[(8.33±1.39) mm]与H1[(7.87±1.35) mm]比较差异有统计学意义(P<0.01)。有颈肩痛组患者ΔH为(3.04±0.42) mm,无颈肩痛组患者ΔH为(1.70±0.51) mm,组间比较差异有统计学意义(P<0.01)。采用Bland-Altman法对无颈肩痛组患者椎间隙高度(H1、H2和H3)与参考高度(H)的一致性进行分析,无颈肩痛组患者H1、H2和H3与H一致性较好。结论:DBD可以将病变椎间隙撑开高度有效控制在2mm以内,便于把病变椎间隙撑开到与邻近节段相似的高度,简便易行。

关键词: 颈椎前路间盘切除植骨融合内固定术, 脊髓型颈椎病, 椎间隙撑开, 间盘切除前撑开, 椎间盘切除

Abstract: Objective: To observe the effect of distraction before discectomy(DBD) in the distraction of the height of anterior cervical space, and to explore its feasibility in restricting the over distraction. Methods: A total of 31 patients with cervical spondylotic myelopathy were treated with anterior cervical discectomy and fusion(ACDF). During surgery, the intervertebral space was distracted before discectomy, the procedure was defined as DBD technique. Before surgery,the distance from the arch top of inferior endplate of upper vertebrae of the index level to the midpoint of superior endplate of lower vertebrae was measured(H0).The same method was used to measure the adjacent proximal and distal intervertebral space heights(Hp and Hd), and the mean value of Hp and Hd,H, was regarded as a referential height that the index intervertebral space should be restored. During operation, the intervertebral space heights before(H1) and after(H2) discectomy with application of DBD were measured with the aforementioned method. The pre-and post-operation index segment heights AB and A'B' were measured respectively. The change of index segment height was defined as ΔH(A'B'-AB),the index intervertebral space height after operation was defined as H3(H0+ΔH). The patients were divided into neck pain group and non-neck pain group according to their post-operative neck pain VAS scores.The radiographic data of the patients in two groups was analyzed and compared with statistical methods. Results: The post-operative neck pain incidence rate was 19.35%. During operation, after DBD, the intervertebral space height change ΔH1 was (1.19±0.51)mm. In non-neck pain group,the difference between H1 (6.95 mm±0.84 mm) and H(6.98 mm±0.70 mm) was not significant(P=0.80), and the difference between H2 (7.31 mm±0.90 mm) and H1(6.95 mm±0.84 mm) was significant(P<0.01).In neck pain group, the difference between H2 (8.33 mm±1.39 mm) and H1 (7.87 mm±1.35 mm) was significant(P<0.01).In neck pain group,the ΔH was (3.04±0.42)mm;in non-neck pain group,the ΔH was (1.70±0.51)mm;the difference between two groups was significant(P<0.01). In non-neck pain group, H1,H2 and H3 had good consistency with H. Conclusion: DBD can effectively control the distraction height of the index intervertebral space within 2 mm, also convenient to let the index intervertebral space be similar with the adjacent segment and easy to follow.

Key words: distraction before discectomy, discectomy, anterior cervical discectomy and fusion, distraction of intervertebral space, cervical spondylotic myelopathy

中图分类号: 

  • R681.5