单节段颈椎间盘突出症合并发育性颈椎管狭窄手术方式选择  

The selection of the operation for the single segmental cervical intervertebral disc herniation combined with the auxano cervical spinal stenosis

作　　者：周俊明[1] 赵新建[1] 廖珊[2] 卢建堂[1] 

机构地区：[1]佛山市第一人民医院骨科,广东佛山528000 [2]佛山市第一人民医院医学统计科

出　　处：《中国骨伤》2005年第6期329-331,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的:通过对65例单节段颈椎间盘突出症合并发育性颈椎管狭窄患者手术治疗回顾分析,评价前后路手术的价值。方法:65例单节段颈椎间盘突出症合并发育性颈椎管狭窄患者中,40例施行前路减压融合钢板固定术,植骨方式有自体髂骨植入、同种异体骨支架和颈椎Cage等;25例施行后路单开门减压椎板成形,分别于术后1周、3个月及1年进行随访,采用JOA分评分标准(17分法)评价其手术效果。结果:40例前路手术均没有出现钢板螺钉脱落、植骨块移位、食道损伤、喉返神经损伤等并发症,8例出现取骨并发症;25例后路单开门减压椎板成形术没有出现硬膜外血肿、门轴滑向椎管等并发症,6例术后3个月出现第5颈神经麻痹症状。40例前路手术患者症状均于术后第1周得到缓解,术后1周、3个月、1年其症状缓解率均优于后路手术。结论:单节段颈椎间盘突出症合并发育性颈椎管狭窄的患者施行前路手术,能直接去除压迫物,起直接减压的作用,手术效果优于后路间接减压。Objective:To review and analysis the operations of 65 patients with single segmental cervical intervertebral disc herniation combined with the auxano cervical spinal stenosis,evaluate the value of the anterior operation and posterior operation.Methods:Among the sixty-five patients,forty were performed anterior decompression and confluence with the cervical plate,and the plant-bone methods including self-iliac bone,cage of the isotype with enoma and the cervical cage.The other twenty-five patients were performed posterior approach of the lamina of the cervical vertebrae.All the patients were followed-up for 2 weeks,3 months,and 1 yerar after operation.The effects of the operation were evaluated with the standard of the JOA's score.Results:All of 40 patients performed the anterior operation without complications such as spliding of the plate and lag screw,displacement of the plant bone and damage of the esophagus and recurrent nerves.The complication of the superscription bone occurred in 8 patient.Twenty-five patients had no complications such as hematom in the epidural and the cervical vertebral canal.Six patients were attacked with 5th cervical paralysis at three months after operation.Symptoms of forty patients with the anterior operation were remissed at the first week after the operation.And the symptom remission rate was excellent than that of the posterior approach during the follow-up period.Conclusion:For the patients with single segmental cervical intervertebral disc herniation with the auxano cervical spinal stenosis,the anterior approach can direct decompression and the effect is excellent than that of the posterior approach.

关 键 词：单节段颈椎间盘突出症 发育性颈椎管狭窄 手术方式 前路手术 后路间接减压术 

分 类 号：R681.53[医药卫生—骨科学] R687.3[医药卫生—外科学]