平山病外科治疗的中期临床效果及影像学结果

doi:10.3969/j.issn.1671-167X.2017.06.015

北京大学学报(医学版) ›› 2017, Vol. 49 ›› Issue (6): 1019-1026. doi: 10.3969/j.issn.1671-167X.2017.06.015

平山病外科治疗的中期临床效果及影像学结果

孙宇1△，刘鑫2，樊东升3，傅渝3，潘胜发1，张凤山1，张立1，王少波1，刁垠泽1，陈欣1，周非非1，赵衍斌1

（1. 北京大学第三医院骨科，北京100191； 2. 北京大学国际医院骨科，北京102206； 3.北京大学第三医院神经内科，北京100191）

出版日期:2017-12-18 发布日期:2017-12-18
通讯作者: 孙宇 E-mail:sunyuor@vip.sina.com

Midterm clinical outcomes and radiological results of surgical treatment for Hirayama disease

SUN Yu1△, LIU Xin2, FAN Dong-sheng3, FU Yu3, PAN Sheng-fa1, ZHANG Feng-shan1, ZHANG Li1, WANG Shao-bo1, DIAO Yin-ze1, CHEN Xin1, ZHOU Fei-fei1, ZHAO Yan-bin1

(1. Department of Orthopedics,Peking University Third Hospital, Beijing 100191, China; 2. Department of Orthopedics, Peking University International Hospital, Beijing 102206, China; 3. Department of Neurology, Peking University Third Hospital, Beijing 100191, China)

Online:2017-12-18 Published:2017-12-18
Contact: SUN Yu E-mail:sunyuor@vip.sina.com

摘要/Abstract

摘要： 目的：回顾性分析应用颈前路融合内固定术治疗平山病的中期临床及影像学结果，探讨外科治疗的意义和价值。方法：36例平山病患者采用颈椎前路融合钛板内固定术治疗，观察术后3个月、1年、2年时肌肉萎缩和肌力变化，测量术后C2-7颈椎活动度的改变及C4-7节段中立位颈椎MRI横断面脊髓面积的改变。结果：（1）临床结果：除1例患者外，所有患者术后肌肉萎缩和肌无力无继续进展。随着时间推移，自觉肌无力改善的患者比例逐年增高：术后3个月为26.5%，术后1年为36.0%，术后2年时有85.7%的患者感觉肌力增加；同时肌萎缩改善的患者比例也逐年增高：术后3个月为8.8%，术后1年为24.0%，术后2年时有35.8%的患者感觉肌萎缩好转。截至术后2年随访时段时，14例患者中有12例受累肌力改善，5例肌肉萎缩得到不同程度改善。（2）影像学结果：C2-7颈椎活动度术后较术前显著减小，由术前平均62.25°±2.10°减少为术后2年时平均13.67°±7.51°（P<0.01）。屈曲位MRI脊髓不再受到压迫。颈椎各个节段MR横断面积：术后3个月时仅C6一个节段的面积较术前增大（P<0.05）；术后1年时C4-5-6三个节段面积均较术前增大（均为P<0.01）；术后2年时C4-5-6-7四个节段面积均较术前增大，其中C4脊髓面积增大15.60%、C5增大19.08%、C6增大21.60%、C7增大23.91%，与术前相比差异均具有统计学意义（P<0.05）。结论：前路内固定植骨融合术是治疗平山病的有效方法，可以获得较好的中期临床转归和影像学结果，对于控制平山病的发展和转归有着积极的意义和价值。

关键词: 平山病, 内固定融合术, 疗效, 影像学

Abstract: Objective： To assess the midterm clinical and radiological outcomes of internal fixation and fusion for the treatment of Hirayama disease and to evaluate the clinical significance and value of this procedure. Methods: In the study, 36 patients were treated with anterior cervical internal fixation and fusion. The clinical outcomes including muscle strength and atrophy were recorded. The radiological outcomes including range of motion of cervical spine and the cross-sectional area of spinal cord at each level on MRI scan were measured before and at 3 month, 1 year and 2 years follow-up time points after sur-gery. Results: (1) Clinical outcomes: all the patients showed no further progression of symptoms except one patient with mild progression of muscular weakness and atrophy. As the time passed by, the ratio of the patients with muscle strength and atrophy improvement increased. There were 26.5% of patients in 3 months, 36.0% in 1 year and 85.7% in 2 years who experienced muscle strength improvement. 8.8% of patients in 3 months, 24.0% in 1 year and 35.8% in 2 years felt muscle atrophy improvement. And 12 of the 14 patients showed improved muscle strength and atrophy at the end of 2 years period follow-up. (2) Radiological outcomes: the range of motion (ROM) of C2-C7 was significantly decreased after the operation. The ROM of preoperation was 62.25°±2.10° and that of 2 years postoperation was 13.67°±7.51°(P<0.01). The spinal cord was of no compression on flexion MRI. The cross-section area of spinal cord on MRI was significantly increased only at C6 level (P<0.05) at the end of three months follow-up. The level of increased cross-section area rose to C4-C5-C6 levels (P<0.01) in 1 year and to C4-C5C6-C7 levels at the end of 2 years follow-up (P<0.05). The cross-section area increased 15.60% at C4, 19.08% at C5, 21.60% at C6 and 23.91% at C7 with significant difference (P<0.05) 2 years after the operation. Conclusion: Anterior cervical internal fixation and fusion is an effective surgical treatment for Hirayama disease and may provide preferable midterm clinical and radiological outcomes. This procedure has clinical significance and value in terms of control of the progression and outcome of this disease.

Key words: Hirayama disease, Internal fixation and fusion, Outcome, Radiology

中图分类号:

孙宇，刘鑫，樊东升，傅渝，潘胜发，张凤山，张立，王少波，刁垠泽，陈欣，周非非，赵衍斌. 平山病外科治疗的中期临床效果及影像学结果[J]. 北京大学学报(医学版), 2017, 49(6): 1019-1026.

SUN Yu, LIU Xin, FAN Dong-sheng, FU Yu, PAN Sheng-fa, ZHANG Feng-shan, ZHANG Li, WANG Shao-bo, DIAO Yin-ze, CHEN Xin， ZHOU Fei-fei, ZHAO Yan-bin. Midterm clinical outcomes and radiological results of surgical treatment for Hirayama disease[J]. Journal of Peking University(Health Sciences), 2017, 49(6): 1019-1026.

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平山病外科治疗的中期临床效果及影像学结果

Midterm clinical outcomes and radiological results of surgical treatment for Hirayama disease

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