神经外科:颈椎病微创手术能根治么

2019-08-07 佚名 杏林之声

颈椎病又称颈椎综合征,是颈椎骨关节炎、增生性颈椎炎、颈神经根综合征、颈椎间盘脱出症的总称,是一种以退行性病理改变为基础的疾患。主要由于颈椎长期劳损、骨质增生,或椎间盘脱出、韧带增厚,致使颈椎脊髓、神经根或椎动脉受压,出现一系列功能障碍的临床综合征。一般表现为椎节失稳、松动;髓核突出或脱出;骨刺形成;韧带肥厚和继发的椎管狭窄等,刺激或压迫了邻近的神经根、脊髓、椎动脉及颈部交感神经等组织,引起一系列症

颈椎病又称颈椎综合征,是颈椎骨关节炎、增生性颈椎炎、颈神经根综合征、颈椎间盘脱出症的总称,是一种以退行性病理改变为基础的疾患。主要由于颈椎长期劳损、骨质增生,或椎间盘脱出、韧带增厚,致使颈椎脊髓、神经根或椎动脉受压,出现一系列功能障碍的临床综合征。一般表现为椎节失稳、松动;髓核突出或脱出;骨刺形成;韧带肥厚和继发的椎管狭窄等,刺激或压迫了邻近的神经根、脊髓、椎动脉及颈部交感神经等组织,引起一系列症状和体征。

1、颈椎病有哪些类型? 临床表现有哪些?

依据其对脊髓、神经、血管等重要组织的压迫,颈椎病可分为神经根型颈椎病、脊髓型颈椎病、椎动脉型颈椎病、交感神经型颈椎病、食管压迫型颈椎病这五种。临床上以前两种最为常见,其具体诊断需要基于相应的临床表现及影像学表现作出。

不同类型的颈椎病临床表现不同,症状也较为复杂。一般表现为颈背部的酸痛,有时还会伴有一侧上肢,或者两侧上肢的过电样的疼痛伴麻木以及肩背部的麻木等一系列的表现,如果压迫了脊髓,患者还会出现走路无力,走路踩棉花感,以及其它的一些症状,个别严重的颈椎病患者,可能还会出现肌肉的萎缩、无力等一系列的表现,如颈背疼痛、上肢无力、手指发麻、下肢乏力等。甚至部分颈椎病人会出现视物模糊、心动过速及吞咽困难等特殊临床表现。总而言之,颈椎病的临床症状不是固定的,与它的病变部位、组织受累程度及病人个体差异有一定关系。

2、颈椎病能用哪些方法治疗?

虽然不同的颈椎病依据其严重程度其治疗方法也不相同,但其总的治疗方法分为以下两大类:

(1)非手术治疗:保守治疗是治疗颈椎病的最主要也是最基本的方法,适合于绝大多数的神经根型、椎动脉型和交感型颈椎病,是除了脊髓型以外的各型颈椎病患者的首选治疗方法。正确地综合应用各种保守治疗,大多数病例可以有很好的效果,甚至达到痊愈;早期症状非常轻微的脊髓型颈椎病也可以先试用保守治疗,并密切观察病情变化,一旦症状加重,则应尽快手术;即使是需要手术治疗的颈椎病患者,在术前准备以及术后康复阶段,进行各种有效的保守治疗也是必不可少的。主要方法包括颈部的休息和制动、各种物理治疗、颈椎牵引、推拿按摩、药物治疗等。

(2)手术治疗:脊髓型颈椎病致残率高,病程延长明显影响手术效果,发生外伤后容易造成急性脊髓损伤,因此一旦确诊,即建议手术。经过规范非手术治疗后无效,症状仍然较重,影响日常生活和工作的其他类型颈椎病,主要是神经根型颈椎病,也建议手术治疗。手术按照入路分为前路和后路手术,目的主要是解除神经的压迫,同时重建颈椎的力学结构。主要术式包括:颈椎间盘切除及植骨融合内固定术、颈椎椎体次全切除及植骨融合内固定术、人工间盘植入术、椎管扩大成形术、颈椎管扩大减压及植骨融合内固定术等。

3、这些手术属于微创吗?疗效如何?

随着外科水平的不断提高,器械的不断改进,以及微创技术的不断涌现,以安全、可靠且小切口的方法治疗颈椎疾病具有了日臻成熟的时机与条件,可以将传统手术做的更加微创,同时衍生出一些新的术式,形成颈椎病手术新的趋势。

具体来讲,在颈前路手术中,无论椎间盘切除,还是椎体次全切除,无论是融合手术还是非融合手术,都可以做到小切口、显微镜下完成手术,真正做到对神经、肌肉组织的微创,术后恢复快,短期内即可出院。在颈后路手术中,可以在经皮通道和显微镜下完成神经根孔减压术,对神经根型颈椎病具有良好的效果。

近年来,随着椎间孔镜在腰椎手术的普遍应用和技术提高,目前已有部分医疗机构开展经皮椎间孔镜技术治疗颈椎病,又称为经皮椎间孔镜辅助下椎间盘切除术,手术视野更清晰,椎管内干扰更少。主要特点就是其技术损伤小,并发症少,术后恢复快,周围组织粘连少,病人满意度高,且相对于传统手术,最大限度地减少了对脊柱活动度、序列的影响,符合人自然的生理力学表现。但应用时间太短,缺乏远期疗效的统计,尚需继续观察和总结。

据统计,显微镜下颈椎病微创手术的手术成功率是94%以上,适用于70%的颈椎病患者,具有诊断更明确、手术精细、安全性高的优点。

4、颈椎病人术后应该注意什么?

①术后每2小时翻身一次(早期由医护人员帮助进行);

②术后垫枕头高低要适宜,仰卧时不宜过高,侧卧时枕头可略高;

③术后若肢体麻木、疼痛症状加重或感觉丧失、出现大小便失禁时,及时向医护人员反映;

④术后 1-2 天行四肢肌力舒缩及各关节的活动;

⑤离床活动时颈部予颈围固定,并避免颈部剧烈转动;

⑥适度加强颈部功能锻炼;

⑦严密监控患者的情况以防意外损伤的发生;

⑧严格遵医嘱定期复查,好根据病人的恢复情况,选择合适的康复治疗方案。

显微镜下实施颈椎病微创手术较传统肉眼手术更为安全,一般不会带来并发症,可是若操作不当,或者患者术后没有好好配合,也会带来一些问题。因此建议,颈椎病手术要由具有丰富临床经验、娴熟的手术技巧的专科医师来施行,且术后要严格遵医嘱,选择合适的康复,并定期复查。在成熟的医疗中心,只要术前诊断明确,选用正确的手术方式,绝大多数患者疗效满意。

专家简介:张风江,郑州大学第一附属医院神经外科副主任医师,副教授

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    2022-04-15 ms3000000877658330

    学习围观

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    2019-08-09 liushui8012

    难,手术有效!

    0

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    2019-08-09 vera_1203
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    2019-08-09 jeanqiuqiu

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