颈椎后凸畸形的临床特征和外科治疗策略VIP免费

·1546·生堡处科盘查垫!Q生!Q旦筮堡鲞筮垫翅垦丛里』坠坚：Q堕!堕!垫!Q：!尘：堡：塑!：垫颈椎后凸畸形的临床特征和外科治疗策略方加虎贾连顺周许辉宋李军蔡卫华李翔【摘要】目的分析颈椎后凸畸形的临床特征和治疗策略。方法自2006年3月至2009年10月治疗颈椎后凸畸形3l例。根据患者的临床特点和影像学表现对其采用不同的治疗方法。手术组9例：男性4例，女性5例，年龄17～72岁，平均35岁；其中继发性后凸畸形4例，特发性颈椎后凸畸形5例。保守治疗组22例：男性1l例，女性11例，年龄14—40岁，平均29岁，均为特发性颈椎后凸畸形。手术组：术前及术后1周，按美国脊髓损伤协会的脊髓损伤神经分级标准(AISA)对患者进行评估，术后定期复查颈椎正侧位X线片，并在手术后1周及之后每6个月复查1次颈椎MRI，以评估患者矫形、融合效果及脊髓减压情况。保守治疗组：每个月拍摄颈椎正侧位x线片评估治疗效果。分析此类患者的临床特征及治疗策略。结果手术组：术后3d颈椎侧位片示：Cobb角平均～1．30(术前54．20)，AISA评分神经功能明显改善，随访时间6一18个月，未见内固定和融合失败。保守组：治疗后4个月Cobb角平均一5．4。(治疗前11．20)，颈项肩背痛症状基本消失，随访3—24个月未见症状复发。结论早期采用体位疗法、石膏支具纠正颈椎生物力学的失衡可以阻止颈椎后凸畸形的发展。根据患者的临床特征，采用个性化的治疗方案，能够充分矫正严重的颈椎后凸畸形。【关键词】颈椎；脊柱后凸；临床特征；治疗策略TheclinicalfeaturesandsurgicaltreatmentstrategiesofcervicalkyphosisFANG．，施一hu，J／AUan—shun，ZHOUXu—hui，SONGLi和，l，CAIWei—hua，UXiang．DepartmentofOrthopaedics，JiangsuProvincialHospital，Nanjing210029，ChinaCorrespondingauthor：12Xiang．Email：lixian92003@medmail．COm．饥【Abstract】0bjectiveToanalyzetheclinicalcharacteristicsandtheSUrgicaltreatmentstrategyofcervicalkyphosis．MethodsFromMarch2006toOctober2009，31casesofcervicalkyphosisweretreated．Accordingtotheclinicalfeaturesandimagingfindings，differenttreatmentmethodswereused．Therewere9patientsinoperationgroup，including4maleand5femalepatients，agedfrom17to72years(averageageof35years)．Amongthem，5caseswereidiopathickyphosisand4caseswerecausedbylaminectomyorotherreasons．Therewere22patientsinconservativetreatmentgroup．including11maleandllfemalepatients，agedfrom14to40years(averageageof29years)，whowereallidiopathiccervicalkyphosis．Beforeandlweekafteroperation，clinicalassessmentweretakenforthepatientsinoperationgroupusingSpinalCordInjuriesClassificationStandardofAmericanSpinalInjuryAssociation(AISA)．Duringtheperiodicreview。theanteroposterior，normalsagittalfilmsofcervicalspineweretaken．Atlweekandevery6monthsafteroperation．MRIfilmswerealsotaken．Thesefilmswerestudiedtoevaluatetheeffectsoftheopertations．Intheconservativegroup，assessmentoftreatmentresultsbystudyinganteropostefiorandnormallateralviewsofcervicalspinewereweretakeneverymonth．TheclinicalcharacteristicsandtheSUrgicaltreatmentstrategiesofthesepatientswereanalyzed．ResulIsInoperationgroup，9caseswerefollowedupfor6tol8months，allpatientsdidnotfailedininternalfixationandfusion．AISAneurologicalSCOreandneurologicalfunctionsignificantlyimproved．ThreedaysafteroperationtheaverageCobbangleWas—1．29。(preoperative54．24。)．Inconservativegroup，theaverageCobbangleWas一5．41。(beforetreatment11．20。)4monthsafterthetreatment．Thesymptomsofneckshoulderandbackpaindisappeared，andallpatientswerefollowedupfor3to24months，withnorecurrenceofsymptoms．ConclusionsIntheearlyperiodofcervicalkyphosis，adoptposturaltherapy，plasterbracestocorrectanimbalanceincerviealspinebiomec...