颈椎前路减压融合术后相邻节段病变的手术治疗  

Surgery for adjacent segment disease after anterior cervical decompression and fusion

作　　者：张宏其[1] 陈凌强[1] 肖勋刚[1] 郭靖[1] 罗继[1] 邓展生[1] 龙文荣[1] 陈静[1] 胡建中[1] 王锡阳[1] 

机构地区：[1]中南大学湘雅医院脊柱外科,长沙410008

出　　处：《中国矫形外科杂志》2006年第23期1774-1777,共4页Orthopedic Journal of China

摘　　要：[目的]探讨颈椎前路椎体次全切减压融合内固定术后相邻节段退行性病变的最佳手术治疗方法。[方法]2000年1月-2004年12月本科共收治33例患相邻节段病变病例，将33例病例分成3型，并分别采用相应的方法：Ⅰ型（单纯椎间盘突出型）20例，行后路侧块螺钉内固定＋前路椎间盘切除植骨融合术；Ⅱ型（黄韧带钙化皱褶型）5例，行后路侧块螺钉内固定＋椎板切除减压术；Ⅲ型（混合型）8例，行后路侧块螺钉内固定＋椎板切除减压＋前路椎间盘切除植骨融合术。[结果]随访6个月～3年，平均1．2年，33例相邻节段病变受压脊髓获得有效减压，内置物无松动断裂，原前路内固定物位置良好、牢固，无血管、神经、气管、食管损伤并发症，骨性融合好，神经功能有明显改善，JOA评分改善率77．8％。[结论]以后路侧块螺钉内固定术为主的3种手术方法是治疗3种类型的相邻节段病变简易积极有效的方法。[ Objective] To discuss the surgery of the adjacent segments degenerative disease after anterior cervical decompression and fusion. [ Method] Thirty-three cases of adjacent segment disease were divided into 3 group, and adopt the corresponding method separately： type Ⅰ （pure intervertebral disk hernia type） 20 cases, adopted posterior lateral mass screw internal fixation and anterior discectomy-grafting-fusion; type Ⅱ （flaval ligaments calcification type） 5 cases, adopted posterior lateral mass screw internal fixation and decompressive laminectomy; type Ⅲ （ mixed type） 8 cases, adopted posterior lateral mass screw internal fixation and decompressive laminectomy and anterior discectomy-grafting-fusion. [ Result ] All cases were followed up for 8 months - 3 years, 1.2 years on average. All the 33 cases＇ compressed spinal cords were decompressed. There was no loosening and fragmentation of the internal fixation material. And the former anterior fixation were firm and in good place. No injury to the arteries, nerves, trachea or esophagus was found. Nerves function had been improved significantly, with the recovery rate being 77. 8% by Japanese Orthopaedic Association （JOA） scoring. [ Conclusion ]All the three operation methods which based on the posterior lateral mass screw internal fixation are simple, positive and effective motheds to adjacent segment diseases.

关 键 词：颈椎 融合术后 相邻节段病变 减压 手术治疗 

分 类 号：R687.42[医药卫生—骨科学]