【摘 要】
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目的：探讨青年颈椎病的临床影像学特点及手术治疗策略.方法：2006年1月～2009年12月在北医三院骨科颈椎组住院治疗的30岁以下的颈椎病患者36例,其中男性28例,女性8例；年龄17-30岁,平均27岁,职员7例,工人5例,农民2例,学生2例.无固定职业者11例,国家公务员6例,教师2例,医师1例.发病时间从1-84个月,平均15.7个月.回顾性分析患者的发病过程,临床及影像学表现,手术入路选择
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目的：探讨青年颈椎病的临床影像学特点及手术治疗策略.方法：2006年1月～2009年12月在北医三院骨科颈椎组住院治疗的30岁以下的颈椎病患者36例,其中男性28例,女性8例；年龄17-30岁,平均27岁,职员7例,工人5例,农民2例,学生2例.无固定职业者11例,国家公务员6例,教师2例,医师1例.发病时间从1-84个月,平均15.7个月.回顾性分析患者的发病过程,临床及影像学表现,手术入路选择.根据X线颈椎正侧伸屈位片采用弧弦距既弧顶与齿突后缘至C7椎体后下角连线的垂直距离来判断颈椎生理曲度的改变,距离正常值是(12±5)mm,当距离＞17mm时为曲线加大,当距离在0.1-0.8mm时为曲线变直,当距离为负值时说明曲线反张.椎体位移测量依White测量法在侧位片上测量.(1)椎体角度位移：在被测相连两椎体的下缘各作一条直线,两直线相交成角；(2)椎体水平位移：被测椎体后缘相对其下一椎体的水平移位.根据JOA17分评分标准随访治疗效果.结果：采取手术治疗的青年颈椎病患者占同期颈椎病手术治疗病例的0.89％,脊髓型颈椎病27例,其中脊髓型颈椎病伴发育性椎管狭窄6例,脊髓型加神经根型颈椎病4例,神经根型颈椎病5例,长期伏案工作者占50％,颈椎生理曲度异常所占比例为90％,颈椎失稳性改变所占比例为39％；前路减压融合固定25例.前路减压人工椎间盘置换7例,后方入路C3—C7单开门椎管扩大成形术3例,前后联合手术1例.31例患者得到随访,随访时间4-30个月,平均16个月.术前JOA评分为5～16分,平均12.90±3.15分,术后3天JOA评分11～17分,平均14.16±2.03分,随访时JOA评分13～17分,平均15.25±1.12分.所有病例均未出现相关并发症.结论：青年颈椎病多发于长期伏案工作人群,颈椎生理曲度异常是青年颈椎病的主要征象特点,颈椎生理曲度异常作为一种x线客观诊断标准,对青年颈椎病患者的早期诊治具有一定的临床意义.颈椎间盘继发于颈椎生理曲度异常而产生退变突出是青年颈椎病的主要致病因素,颈部软组织失衡也可能是青年颈椎病的一个重要致病因素.对于大多数青年颈椎病患者,前路手术可以创造条件为其尽快恢复受损神经功能或阻止其恶化,提高其生活质量,降低致残率.少部分伴有发育性颈椎管狭窄的青年颈椎病患者行后路椎板成形术或前后路联合手术可取得满意疗效.
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