前路分节段减压植骨融合术在治疗多节段脊髓型颈椎病的临床疗效分析  

Analysis of curative effects on the segmental anterior cervical decompression and fusion for treating multi-segmental on cervical myelopathy

作　　者：陈忠羡[1] 付朝华[1] 梁胜根[1] 范全[1] 薛忠林[1] 谢清华[1] 赵振东[1] 原向伟[1] 雷洪俊[1] 秦英 

机构地区：[1]中山大学附属江门医院骨科,广东江门529070

出　　处：《岭南现代临床外科》2012年第6期463-465,472,共4页Lingnan Modern Clinics in Surgery

基　　金：江门市科技局立项项目(2010031江科)

摘　　要：目的探讨经前路分节段减压植骨融合术治疗多节段颈椎病的临床效果。方法对我院近3年收治的37例多节段颈椎病患者采用分节段减压术的连续性资料,其中21例3节段患者采用单间隙减压+单椎体次全切除植骨融合内固定术治疗,16例4节段段患者采用保留C5椎体的切除C4、C6椎体的分节段减压。分析手术时间、术中出血量、术后6个月植骨融合率、JOA评分改善率,节段性前突角度。结果所有患者均获随访,平均12个月。手术时间110～230min,平均155min。术中失血约150～650mL,平均325.5mL。术后颈椎X线照片提示均恢复颈椎生理曲度,及椎间高度;6个月植骨融合率91.8%。无植骨块脱出、钢板螺钉折断、脑脊液瘘等严重并发症发生。术后3、6个月JOA评分为(13.6±1.9)、(14.0±1.6)分,术后3、6个月平均改善率为53.4%、58.9%。节段性前突角度术前(9.68±3.2)°,术后(16.52±2.2)°。结论颈前路分节段减压植骨融合术治疗多节段颈椎病是较好的手术方式,值得提倡。Objective To investigate the clinical effect of segmental anterior cervical decompression with fusion on multilevel cervical myelopathy.Method Twenty-seven patients with multilevel cervical myelopathy underwent single space decompression plus single vertebral body subtotal resection and fusion of internal fixation.Of them,sixty cases with 4 sigmental lesions underwent conserving-C5 vertebral body and segmental decompression of subtotal resection of C4 and C6 vertebral bodies.The operation time,volume of intraoperative bleeding,sixth month bone grafting fusion rate after operation,JOA score improved rate and segmental lordotic angle were analyzed.Result All patients were followed up with an average of 12 months.The operation time was in 110-230 mimutes.Blood loss was Volume of intraoperative blood loss was 150-650 mL(an average of 325.5 mL).The cervical vertebral physiologic curve and intervertebral height were restored in all cases after operation.By X ray examination,the six-month bone grafting fusion rate was 91.8%.No profusion of bone grafting mass,no breaking of plate and screw and no leakage of cerebrospinal fluid were found after operation,postoperative 3 months and 6 months.JOA score were 13.6±1.9,14.0±1.6 resoectively.The average improved rates of postoperative 3 months and 6 months were 53.4% and 58.9%.Preoperative and postoperative segmental lordotic angles were 16.52 ±2.2.Conclusion Segmental anterior cervical decompression plus bone grafting fusion possesses a good curative effect for treating multilevel cervical spondylotic myelopathy.

关 键 词：多节段颈椎病 手术 分节段减压 植骨 融合 

分 类 号：R681.5[医药卫生—骨科学]