摘要
[目的]研究外科治疗颈椎不稳定所致眩晕的中期随访效果。[方法]2000年10月～2006年6月采用前瞻性研究方法对颈椎不稳定所致眩晕的28例患者实施了手术治疗,其中女21例,男7例;平均年龄42.5岁(30～56岁)。颈椎不稳定节段包括C3、4单节段12例,其中6例合并脊髓损伤;C4、5单节段8例,其中4例合并脊髓损伤;C5、6单节段合并脊髓损伤1例;C3、4和C4、5双节段合并脊髓损伤4例;C4、5和C5、6双节段合并脊髓损伤3例。手术方法为不稳定节段的前路间盘切除+椎间融合器植骨融合或椎间植骨钢板内固定。采用JOA评分评价脊髓功能。[结果]所有患者平均随访43个月(30～60个月),绝大部分患者在术后3个月后头晕及颈肩部不适等主要症状缓解满意。至最后随访时,22例患者术前眩晕和颈椎不适症状完全缓解,无复发;4例症状完全缓解或明显减轻后又出现症状复发,但较术前症状减轻;2例患者头晕症状改善不甚满意。脊髓功能均得到明显改善,由术前平均10.10分增加至术后平均14.90分,统计学差异显著(P<0.05)。3例患者出现融合临近上方节段的不稳定,但无明显眩晕症状。[结论]对颈椎不稳定所致的颈源性眩晕患者,在确定其关系的前提下,根据影像学上的不稳特点,选择合适的手术入路及内固定方法可获得较满意的中期效果。
[ Objective ] To investigate the medium-term outcomes of surgical treatment of vertigo secondary to cervical spinal instability. [ Method ] From Oct. 2000 to Jun. 2006, 28 patients underwent operation for vertigo secondary to cervical spinal instability and were followed prospectively. There were 21 females and 7 males with an average age of 42. 5 years （rang, 30 to 56 years）. The involved levels included C3、4 in 12 cases, C4、5 in 8, combined C3、4 and C4、5 in 4, and combined C4、5 and C5、6 in 3. Surgical methods included anterior discectomy and fusion with interbody bone grafting and internal fixation with plate or fusion with cages. JOA score system was used for the evaluation of neurological function. [ Result] All the patients were followed for 43 months （30 to 60 months）. Satisfactory results were achieved in most of the patiens 3 months after surgery. At latest follow-up, complete relief of the preoperative complaints was obtained in 22 patients with incomplete relief in 4 and no obvious improvement in 2. Neurological function was improved from preoperative JOA 10. 10 to postoperative JOA 14. 90 with satistically significance. Adjacent unstable segments proximal to fuxion level were noted in three cases but with no recurrence of the preoperative symptoms. [ Conclusion] For properly selected patients with vertigo secondary to unstable cervical spine, satisfactory medium-term clinical outcomes can be achieved appropriate surgical methods.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2007年第17期1304-1306,共3页
Orthopedic Journal of China
关键词
颈椎
眩晕
不稳定
手术
cervical spine
vertigo
instability
operation
