[1]孙新立 周非非* 孙宇 张凤山 张立 潘胜发.颈椎前路微创手术后再次翻修手术的原因分析[J].中国微创外科杂志,2021,01(3):226-230.
　Sun Xinli,Zhou Feifei,Sun Yu,et al.Cause Analysis of Revision Surgery After Minimally Invasive Anterior Cervical Surgery[J].Chinese Journal of Minimally Invasive Surgery,2021,01(3):226-230.
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颈椎前路微创手术后再次翻修手术的原因分析()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2021年3期
页码:
226-230
栏目:
临床研究
出版日期:
2021-04-01

文章信息/Info

Title:
Cause Analysis of Revision Surgery After Minimally Invasive Anterior Cervical Surgery
作者:
孙新立 周非非* 孙宇 张凤山 张立 潘胜发
（北京大学第三医院骨科脊柱疾病研究北京市重点实验室，北京100191）
Author(s):
Sun Xinli;  Zhou Feifei;  Sun Yu;  et al.
Department of Orthopedics, Peking University Third Hospital, Beijing Key Laboratory of Spinal Disease Research, Beijing 100191, China
关键词:
颈椎前路手术; 颈椎病; 颈椎翻修手术
Keywords:
Anterior cervical surgery; Cervical spondylotic disease; Cervical revision surgery
文献标志码:
A
摘要:
目的探讨颈椎前路微创手术后再次翻修手术的原因及效果。方法回顾性分析2007年1月~2018年6月34例颈椎病在外院行颈椎前路经皮微创手术后再次来我院行翻修手术的临床资料，应用改良日本矫形外科学会（Japanese Orthopaedic Association，JOA）17评分评价翻修术后神经功能改善情况，疼痛视觉模拟评分 （Visual Analogue Scale，VAS）评价翻修术前后颈痛及上肢痛情况，欧洲五维健康量表（EuroQol Five Dimensions Questionnaire，EQ5D）评价患者生活质量改善情况。结果31例随访1~12年，中位数4.5年。末次随访改良JOA17评分由术前（11.6±2.6）分提高到（15.3±1.5）分（t=-7.710，P=0.000）；术前颈痛和上肢痛VAS评分中位数分别为4、2分，末次随访中位数分别为1、0分（Z=-3.302,P=0001;Z=-2.670,P=0.008）；EQ5D指数由术前0.555±0.176改善到末次随访0.848±0.214（t=-9.198，P=0.000）。结论对于脊髓型颈椎病、混合型颈椎病、无骨折脱位型颈脊髓损伤或影像学合并发育性颈椎管狭窄、后纵韧带骨化或颈椎不稳的患者，不宜行颈椎前路经皮微创手术，需严格掌握手术适应证。若微创手术效果不满意或出现感染、椎管内血肿等造成神经功能障碍应及时行翻修手术，效果确切。
Abstract:
ObjectiveTo analyze and discuss the causes and effects of revision surgery after minimally invasive anterior cervical surgery.MethodsA retrospective analysis was performed on 34 patients with cervical spondylotic disease who underwent anterior cervical percutaneous minimally invasive surgery in other hospitals and revision surgery in our hospital from January 2007 to June 2018. The original diagnosis and imaging characteristics of the patients were analyzed, the curative effect of minimally invasive surgery and postoperative complications of minimally invasive surgery were recorded, and the types of revision surgery were summarized. The modified JOA17 score was used to evaluate the improvement of neurological function before and after revision, the Visual Analogue Scale(VAS) was used to evaluate the improvement of neck pain and upper limb pain before and after revision, and the EuroQol Five Dimensions Questionnaire（EQ5D） score was used to evaluate the improvement of patients’ quality of life.ResultsA total of 31 patients were followed up for a median of 4.5 years (range, 1-12 years). At the last followup, the modified JOA17 score increased from (11.6±2.6) points to (15.3±1.5) points (t=-7.710, P=0.000). The median preoperative VAS score of neck pain and upper limb pain were 4 and 2 points respectively, and the median at the last followup were 1 and 0 points respectively (Z=-3.302, P=0.001; Z=-2.670, P=0.008). The EQ5D improved from 0.555±0.176 to 0.848±0.214 (t=-9.198, P=0000).ConclusionsFor patients with cervical spondylotic myelopathy, cervical spondylotic myeloradiculopathy, cervical spinal cord injury without fracture and dislocation or imaging combined with developmental cervical spinal stenosis, posterior longitudinal ligament ossification or cervical instability, it is not appropriate to perform anterior cervical minimally invasive surgery, and the surgical indications should be strictly controlled. The effect of revision surgery is satisfactory, if the effect of minimally invasive surgery is not satisfactory or the occurrence of infection, spinal hematoma and other neurological dysfunction.

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备注/Memo

备注/Memo:
*通讯作者，Email：orthozhou@163.com
更新日期/Last Update: 2021-06-09