颈前路手术治疗颈椎伤病若干问题探讨  

Discuss the problems of anterior cervical surgeries in treating cervical spondylosis

作　　者：周章彦[1] 周茂垣[1] 连福明[1] 林智勤[1] 谢彬[1] 朱轶[1] 

机构地区：[1]福建省三明市第一医院骨科,福建三明365000

出　　处：《生物骨科材料与临床研究》2006年第3期16-18,共3页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的探讨颈前路手术治疗颈椎伤病若干问题。方法本组18例,颈椎病7例,颈椎骨折脱位伴外伤性椎间盘突出10例,颈椎炎症破坏1例,行颈前路伤病椎节间盘切除,椎体次全切除、减压、后纵韧带作选择性切除、骼骨植骨、钛钢板固定。结果随访3-19个月,无发生与手术相关并发症。 ASIA分级中A级2例无改善,C级5例改善至D级,D级3例中2例改善至E级,1例无改善。JOA评分 13-17分。1例术后继发应激性上消化道出血致死。复查X片,骨折复位良好,无断钉、断板、钢板松脱、椎间高度丢失,植骨块无移位、融合好,内固定位置好。结论颈髓损伤后8小时内应用大剂量甲基强的松龙,可有效治疗脊髓继发性损伤,促进神经功能恢复。既要及时、充分减压又要最大限度保护颈椎功能。要尽量保护具有安全稳定作用的后纵韧带完整性,必要时可作选择性切除。对施术椎节行确实的植骨融合固定是取得良好疗效的根本保障。Objective To discuss the problems of anterior cervical surgeries in treating cervical spondylosis. Method there are 18 cases in this research, including 7 cases of cervical spondylosis, 10 cases of cervical fracture and dislocation combined with traumatic Protrusion ofintervertebral disc （PID） and 1 caseofcervical inflammation. For treatment, we performed anterior cervical Intervertebral discectomy, anterior cervical disc ectomy, decompression, posterior longitudinal ligament selective-ectomy, iliac bone grafting, and titanic plate fixation. Result The follow-up survey lasted for 3 to 19 months, during which there was no operation related inflammation. 2 case in Class A made no improvement, 5 cases of Class C were improved to Class D, among the 3casesofClassD, 2 cases were improved to Class E, 1 case made no improvement. The JOA score rose from 13 to 17. One case died from post-operation secondary upper gastrointestinal bleeding. Reexamination of the Xray film showed that the fracture reposition was good and there was no broken nail or broken plate, nor loose plate, Intervertebral spaces were restored after operation, all grafting bones got solid fusion, the internal fixation is well positioned. Conclusion During the operation, we should try to obtain both sufficient decompression and the maximum protection over the function of cervical vertebra and try to protect the completeness of posterior longitudinal ligament which can sustain the stability of spine. Selective-ectomy may be adopted when necessary. Solid interbodv fusion fixation is the basic guarantee for the effective results.

关 键 词：颈前路减压 椎间盘切除 椎体次全切除 植骨融合 内固定 

分 类 号：R687.3[医药卫生—骨科学]