【doc】单开门椎管扩大成形术对颈椎管狭窄症患者颈椎功能的重建作用

【doc】单开门椎管扩大成形术对颈椎管狭窄症患者颈椎功能的重建作用 单开门椎管扩大成形术对颈椎管狭窄症患 者颈椎功能的重建作用 1SSN1671—5926CN21—1470/R帮办?中国临床康复2005年7月14日第9卷第 26期 valuatethefeedbackandimproveitinclinic REFERENCES 1MinistryofPubicHealthofthePRC.Guidelinesofnewdrugsfor(ineseHerb oftClinicalResearchPed.1993:24—5 2JacobsonGP.NewmanCW.Thedevelopmentofthedizzinesshandicapinven- tory.Archoto~lheadnecksurg1990:116:424—7 3WangCH,ZhuoDH.Apreliminaryevaluationofsymptomsandfunctionsof patientswithcervicalvertigo.ZhongguoKangfuYixueZazhi(中国康复医学杂 志11998;13f61:245—7 4SunY.Summaryofthesecondsessionofcervicalspondylosis.ZhonghuaWaike Zazhi(中华外科杂志)1993;31(8):472—6 5RascolO.HainTC.Antivertigomedicationsanddrug-inducedvertigoDrug 1995;50(5):77 6AronsonTA,LogueCM.Phenomenologyofpanicattacks:adescriptivestudyof panicdisorderpatients.seIf-reports.JClinPsychiatry1988;49:8—13 7ClarkDB,HirschBE,SmithMG,eta1.Panicinotolaryngologypatientspre- sentingwithdizzinessorhearingloss.AmJPsychiatry1994;151:1223—125 8WangJL.Clinicalidemiology2ed.Shanghai:ShanghaiScienceandTech- nologyPublishingHouse2001:362—4 建立椎动脉型颈椎病的功能评定量 魏毅,梁伟雄,蔡业峰('广州医学院药理教研室,广东省广州市 510182;广州中医药大学临床流行病学/DME中心,广东省广州市 510407;广东省中医院神经内科,广东省广州市510120) 通讯作者:魏毅?,1973年生,男,福建省福州市人,汉族,2o02年广 州中医药大学医学毕业,硕士,讲师,主要从事老年心血管疾病的研究. 广东省中医药局资助课题(BOl007) 摘要 背景:目前有临床应用的颈性眩晕症状与功能评估量表可对椎动脉型 颈椎病患者整体层次疗效进行评价,但该量表对日常生活功能方面的 评价缺乏功能状态和心理功能方面的内容. 目的:在借鉴国外眩晕障碍量表基础上,探索性建立包括功能状态和心 221 理功能两个方面内容的椎动脉型颈椎病功能评定量表. :横断面调查,预试验后的访谈式测评,内在信度,重测信度,结构 效度分别采用克朗巴赫法,"Pearson"相关系数法和因子分析法测量. 单位:广州中医药大学临床流行病学/DME中心. 对象:选择2001—05/2002—03广东省中医院颈椎病专科门诊的连续椎 动脉型颈椎病患者111例,男3O例,女81例;年龄31~72岁.有椎一基 动脉硬化危险因素者36例.轻度眩晕l4例,中度眩晕6l例,重度眩晕 36例,均知情同意参与本调查. 方法:在借鉴国外相关量表的基础上,结合临床实际情况制订椎动脉型 颈椎病功能评定量表,主要内容两大方面.?功能状态(独自白天步 行出门,晚上户外散步,做较重的家务,社交活动,外出活动,上床, 起床和看书,报纸7项,每项分为"没有,有一些,有"3个等级).(心 理功能(情绪低落,烦躁不安,担心病情和挫折感4项,每项分为"没 有,有一些,有"3个等级).采用访谈式测评椎动脉型颈椎病患者,并 对其中l4例进行重复测评.用SPSS10.0进行量表的信度,效度检 验及相关性分析. 结果:111例患者均进入结果分析.?椎动脉型颈椎病功能评定量表的 功能状态维度和心理功能维度及总量表的克朗巴赫值分别为0.8759, 0.6453,0.8595;重测信度值(r)分别为0.8603,0.7148,0.8237.?因 子分析显示提取的公因子与两个构想维度相吻合. 结论:?建立在患者整体层次上的椎动脉型颈椎病功能评定量表具有 较好的信度和效度.?该量表作为一个独立的测量工具,量化了椎动脉 型颈椎病患者的生存质量,使对椎动脉型颈椎病的评定更加全面.?可 用于观察药物疗效或筛选最佳的治疗,该评定量表具有临床实用 价值. 主题词:颈椎;椎底动脉供血不足;心理测定学;评价研究 中图分类号:681.5文献标识码:A文章编号:1671—5962一(2005】26一O219一 O3 魏毅,梁伟雄,蔡业峰建立椎动脉型颈椎病的功能评定量表U】_中国临床康复, 2005,9(26):219—21[wwwzglcldcoml (EditedbyFanXH/SongLP/'WangL) ? CLINICALREsEARCH? Functionalreconstructionofcervicalvertebrainpatientswith '?'-???-?'?ll? cervicalsoinalstenoticmyelopathythroughexpanslve open—doorlaminoplasty? OuonZheng—xueOuYun—sheng,AnHong DepartmentofOrthopaedics.FirstAmliatedHospitalofChongqingMedical University.Chongqing4oo0l6,China Correspondenceto:OuanZheng—xue?,Master,Associateprofessor,De. partmentofOrthopaedics,FirstAffiliatedHospitalofChongqingMedical University.Chongqing4oo0l6.Chinaa687O3567@cta.cq.cn Received:2005—1O一25Accepted:2oo5一O1—28f03/GW) Abstract BACKGROUND-Themainmethodtotreateervicalspinalstenotic myelopathycausedbyvariousfactorsisposteriorlamninectomy,butthe postoperativeeffectwasnotsatisfactory. 0BJECTIVE:Toobservethepostoperativefunctionalreconstructionof thecervicalvertebraofthepatientswithcervicalspinalstenoticmyelopa. thythroughexpansiveopen—doorlaminoplasty. DESIGN:Anobservationalstudybycomparingthechangesbeforeandaf- tertheoperation. SErr】NG:DepartmentofOrthopaedicsoftheFirstAmliatedHospitalof ChongqingMedicalUniversity. PARTIC?'ANTS:Totally32patientsr22maleandlOfemale1withmu1. ti--segmentcervicalspinalstenoticmyelopathyweretreatedattheDepart-- mentofOrthopaedicsoftheFirstAffiliatedHospitalofChongqingMedical UniversityfromMayl995toMay2004.Twelveeasessufferedfromdegen. erativespinalcanalstenosiscausedbyspinalcordtypeofcervicalspondy- losis.18casessufferedfromdevelopmentalspinalcanalstenosisand2 fromossificationofcervicalposteriorlongitudinalligament(OP. METHODS:Altogether32casesweretreatedthroughexpansiveopen- doorlaminoplastytothecervicalspine.Thesepatientshadbeenfoflowed uDfr6monthsaftertheinformedconsentwasobtained.Thespinalfunc. tionwasevaluatedaccordingtoJapaneseOrthopaedicAssociation17 scoresbeforeoperation,2weeksand3monthsaftertheoperationrespec— tively.Theradianofthecervicalvertebra,thestabilityofthespinalcol— UlTalandthecomplicationswereobservedwithX.ray. MA0UTC0MMASURES:(1)Thespinalfunctionofthepatients beforeandafteroperation,?Theradianofthecervicalvertebra,thesta- bilityofthespinalcolumnandthecomplicationsaftertheoperation. RESULTS:Accordingtointention.to.treatanalysis.allthe32patientsen. teredthestageofresultanalysis.?Spinalfunctionevaluationofthepa- tientsbeforeandaftertheoperation:Accordingtotheevaluationstandard stipulatedbyJapaneseOrthopaedicAssociation(JOA),twoweeksandthree monthsaftertheoperation,thescoringofthespinalfunctionwassigrfifi- cantlyhigherin12casesofcervicalspondylosismyelopathy-inducedde- generativestenosis.18casesofdevelopmentalspinalstenosisand2cases ofossificationofcervicalposteriorlongitudinalligament(OPLL)(Thescore was5.2,5.7,5.5pointsrespectivelybeforetheoperation;9.2,9.7,9.4 pointsrespectively2weeksaftertheoperation;andll-3,l1.8,l1.6 pointsrespectively3monthsaftertheoperation).(Thechangesofthera- dianofthecervicalvertebra,thestabilityofspinalcolumn,andthecom. plicationsaftertheoperation:Radiographsindicatedvanishedcervicalan. teflexioncurvatureandstraishtenedcervicalvertebraeinthreecases,but nore-closureorunstablespinehappened. C0NCLUS10N:Expansiveopen.doorlaminoplastyforcervicalspinal canalstenosiscausedbyvariousfactorscanstillimproveandincreasethe spinalfunctionalevaluationscoresshortlyand3monthsaftertheopera. tion,anditdoesnotaffectthestabilityofthecervicalvertebrae. OuonZX.OuYS,AnHFundionalreconstructionofcervicalvertebrainpa?