Đặc điểm lâm sàng, chẩn đoán hình ảnh và kết quả phẫu thuật tạo hình cung sau sử dụng nẹp vít điều trị bệnh hẹp ống sống cổ do thoái hóa tt tiếng anh

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QUESTION Cervical spinal stenosis due to degeneration is a common spinal pathology in middle-aged people Cervical spine stenosis can present many clinical symptoms with different levels: from cervical spine pain, shoulder pain or radiculopathy The treatment cervical stenosis restores cervical spine function, relieves pain, restore movement, brings patients back to normal life In surgical treatment, for one or two levels cervical stenosis, the authors often have used anterior procedures Japanese authors have used laminoplasty to expand the cervical spine canal in order to limit the disadvantages of laminectomy In Vietnam, the treatment of multilevels cervical stenosis by laminoplasty has also achieved much more improvement Since 2009, at 108 Military Central Hospital, we have used titanium mini-plates in maxillofacial surgery to laminoplasty Until now, through medical literature reference in our country, we found that, there has not been a domestic research project that has fully and detailed research on diagnosis, surgical treatment as well as the result of laminoplasty with titanium mini-plate Therefore, we carried out the project "Clinical characteristics, image diagnosis and operative results of open door laminoplasty using maxillo-facial mini plate to treatment cervical stenosis due to degeneration" with two objectives: Describe clinical features and images of cervical stenosis in patients with multilevels stenosis due to degeneration, had laminoplasty indication Evaluation of surgical results, some factors related to surgical results and applicability of laminopasty surgery procedure New contributions of the thesis: Describe the clinical characteristics and images of patients group with multi-levels cervical stenosis due to degeneration who had cervical laminoplasty indication The dynamic magnetic resonance imaging method of cervical spine allows an accurate assessment spinal cord compression condition in positions However, it has not been mentioned in domestic medicine literature This is a new finding of the thesis It helps clinicians having a comprehensive view and diagnostic orientation for patients who not have suitalbe between clinical signs and and magnetic resonance images Laminoplasty brings many benefits: range of motion preserved, good neurological recovery, safety, less complications Laminoplasty using maxillofacial tinanium mini-plate save treatment costs while ensuring safety and treatment effectiveness The layout of the thesis: The content of the thesis is presented in 110 pages, including chapters Question: 02 pages; Chapter – Overview document: 37 pages; Chapter – Patients and research methods: 18 pages; Chapter - Research results: 23 pages; Chapter - Discussion: 28 pages; Conclusion: pages The thesis includes: 36 tables, 43 figures Reference: 150 documents Chapter OVERVIEW DOCUMENT 1.1 History of laminoplasty research in the treatment myelopathy due to cervical stenosis 1.1.1 In the world In 1968, Kirita et al used air drill to cervical laminectomy, showed a significant improvement in the clinical situation as well as a reduction complications rate compared to using kerrison Many laminoplasty techniques were developed based on the using air drill machines such as the Z laminoplasty of Oyama and Hattori (1973) Hirabayashi's technique was expansive open door laminoplasty of unilateral hinge type (1977) In 1980, Kurokawa et al developed double-door laminoplasty technique (spinous process splitting laminoplasty) Since then, the laminoplasty of cervical spine falls into two categories according to the design of the osteotomy: the unilateral hing-type method such as Hirabayashi's and bilateral hinge-type method such as Kurokawa’s 1.1.2 The situation of cervical laminoplasty researches in Viet Nam In Vietnam, the cervical myelopathypathy has been diagnosed and treated in the 90s of the 20 century Diagnosis of cervical stenosis with cervical myelography and then by magnetic resonance imaging Since 1995, at the Department of Spinal A, Ho Chi Minh City Orthopedic Trauma Center, Vo Van Thanh et al have begun to treat cervical stenosis by surgery Nguyen Trong Yen and Pham Hoa Binh (2009) reported the initial results of cervical stenosis surgery by laminoplasty using maxill-facial titanium mini-plate for satisfactory results Phan Quang Son (2015) published the topic of treatment of cervical stenosis by laminoplasty combined with using coral graft, recovery rate was 58.5 ± 12.8%, good and excellent results was 81.2% The researches on surgical treatment of the medullary pathology due to the above mentioned stenosis stenosis mainly intervene in the front, only a few studies interfering with the posterior way by the method of creating the back bow as the author Vo Van Thanh, Phan Quang Son, These studies use the method of creating the rear arc with hinge on either side or hinged on one side fixed the back bow with steel thread while the method of creating the rear arc is hinged on one side The modification with the use of facial jaw titanium braces only had one report by Nguyen Trong Yen and Pham Hoa Binh with patients, as well as no long-term followup studies on the treatment results of this method Our research was designed to answer these requirements Chapter SUBJECTS AND METHODS OF RESEARCH 2.1 Research subjects Consisting of 31 patients with diagnosis of multilevel cervical stenosis due to degeneration had operatived by cervical laminoplasty using titanium miniplate and screws at 108 Central Military Hospital from February 2011 to October 2015 2.1.1 Standard selection of patients - Clinical examination of patients with cervical myelopathy - Imaging diagnosis: There was no cervical kyphosis (lordosis angle > 0), no ossification of posterior longitudnal ligament On the magnetic resonance imaging: Multilevels spinal cord compression ( levels or more) due to degeneration (hypertrophy of the ligaments, swelling of the disc, bone mine, loss of cerebrospinal fluid around the spinal cord ) - Surgical treatment by post-arterioplasty using facial jaw screw splint - Followed and treated after surgery according to the uniform process 2.1.2 Exclusion criteria - Patients with cervical stenosis due to degeneration was operatived by cervical laminoplasty using maxillofacial plate combined with another surgery on the cervical spine - Patients with cervical stenosis due to degeneration had other previous surgeries on the vertebrae - Patients did not agree to participate in the study, or patients with cervical stenosis due to degeneration were treated laminoplasty but inadequate monitoring, not enough research data 2.2 Research methods 2.2.1 Research design Describe the series of cases, prospective, no control 2.2.2 Sample selection and sample size Sample size is calculated according to the formula: *p*(1-p)]/d2 N=[ Z: numerical value from normal distribution, with error type = 0.05, Z(1-/2) = 1,96 p: expected value of ratio = 0.92 d: accuracy = 0.1 Calculated: N = 28.3 2.2.3 Research content 2.2.3.1 Clinical research - Clinical symptoms of multistage spinal stenosis due to degeneration were noted 2.2.3.2 Research on image diagnosis - Image characteristics on X-ray film, computerized tomography and magnetic resonance imaging were recorded and analyzed 2.2.3.3 Research on surgical treatment - Anesthesia: endotracheal anesthesia - Patients position: prone with a cervical spine bent or in an intermediate position - Surgical tools: + Set of specialized tools for spinal surgery + Titanium mini palte and screws of Biomet Microfixation Company + Surgical microscope + High speed drilling machine + X-ray machine (C-arm) during surgery - Surgical technique: Step 1: Expose spinal processes, laminla and lateral masses Step 2: Create hinges and open doors along both sides of the laminas Step 3: Spinal cord decompression Step 4: Put the plate and screw to fix laminas at the door opening position Step 5: Close the incision - Evaluation in surgery: + Which is the hinge side + Number of laminas were laminoplasty did + Time amount of surgery + Blood transfusion during surgery - Accidents and complications: + Accident in surgery: tearing of the dural sac, spinal cord and nerve roots injury, fracture of lamina + Postoperative complications: incision infection, cerebrospinal fluid leakage, meningitis, epidural hemorrhage, paralysis C5 after surgery, cevical kyphosis post operation 2.2.3.4 Evaluation of surgical results - Evaluation time: + The close results were assessed when the patient was discharged + The far results were recorded after surgery 12 months - Evaluation of clinical results: + The rate of recovery Hirabayashi Recovery rate (%) = (post-op JOA score – pre-op JOA score) (17 – pre-op JOA score) x 100 + Split into groups:  Excellent (recovery rate ≥ 75%)  Good (50 ≤ recovery rate
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