颈椎前路融合手术后的翻修手术.pdf

华 中 科 技 大 学 硕 士 学 位 论 文 ABSTRACT Objective: To analyze the reasons why patients wit cervical spondylotic myelopathy underwent revision surgeryandto describethe surgical strategiesforrevision surgeryand to evaluatethe clinical outcome ofthe revision surgery.Methods:The clinical data of 31 patientswhounderwentcervicalrevisionsurgerybetween2012and2014werereviewedto analyze the reasons for revision surgery, the surgical strategies and the clinical outcome. Results:Allpatients were followedup for 3to 36months wit an average of 19months. The reason for revision surgery was adjacent segment disease in 23 (74%), inadequate decompression in4 (13%),pseudarthrosis in2 (6.5%)and loosing fixationin2 (6.5%) of those patients. Thirty-two patients (97%) improved postoperatively as measured by the Nurick Myelopathy Scale. Complications suc as Spinal cord injury, cerebrospinal fluid leakage, esophageal injury, wound infection are not found. Conclusion: Most revisions were done for adjacent segmentdisease. Surgicalrevision shouldbe based onthe specific circumstancesofthepatient,includingpressure-inducedreasons,theextentofstenosis the ， cervicalsagittalalignmentetc.Althoug therevisionsurgeryhashig riskofcomplications, itcanobtaingoodclinicaleffects. Key words: Cervical spondylosis Cervical spondylotic myelopathy; revision surgery; ； adjacentsegmentdisease;pseudarthrosis 2 华 中 科 技 大 学 硕 士 学 位 论 文 一、前 言 脊髓型颈椎病在脊柱外科疾病中占有相当大的比例。而颈椎前路椎间盘切除术加 ACDF 融合内固定术 （ ）一直是治疗脊髓型颈椎病非常重要的手术方式之一。近年来， 随着手术技术的普及和手术器械的改进，颈前路减压植骨融合内固定术得以大量的开 展。然而，一部分患者术后临床症状改善不明显，或出现了并发症，或一段时间后再 次出现脊髓受压的临床症状，这就需要翻修手术的干预。Bohlman等 最早报道大量1 6 11 颈前路减压植骨融合的病例，平均随访 年，发现有 例发生了临近节段