前路开槽减压固定加人工椎间盘置换术治疗多节段脊髓型颈椎病  

Treatment of cervical spondylotic myelopathy with multi-level involved by anterior cervical decompression,autograft fusion and cervical artificial disc replacement

作　　者：王文军[1] 朱永顺[1] 王麓山[1] 姚女兆[1] 刘利乐[1] 

机构地区：[1]南华大学附一医院脊柱外科,衡阳市421001

出　　处：《中国脊柱脊髓杂志》2007年第3期182-185,共4页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:评价前路开槽减压固定加人工椎间盘置换术治疗多节段脊髓型颈椎病的临床疗效。方法:回顾性分析自2004年6月至2006年6月期间,采用前路开槽减压固定加人工椎间盘置换治疗的15例多节段脊髓型颈椎病患者的临床资料,根据术前、术后、随访时的颈椎标准侧位X线片,观察植骨融合、内固定及人工椎间盘的情况,以JOA评分评价神经功能改善情况。结果:经过3～24个月(平均13个月)随访,所有病例内置物无松动、移位,植骨融合时间在3～7个月,平均4.5个月。置换间隙术前平均活动度为12.8°±5.7°,术后1年时为11.2°±5.4°,与术前比较无统计学差异(P>0.05)。术前JOA评分为10.3分,术后3个月时为13.8分,平均改善率为52.5%,其中优7例,良5例,中2例,差1例。结论:前路开槽减压固定加人工椎间盘置换术治疗多节段脊髓型颈椎病能达到彻底减压同时减少固定融合节段。Objective：To investigate the clinical result of surgical treatment of cervical spondylotic myelopathy （CSM） with multi-level involved.Method：15 cases of multi-level CSM between Jun 2004 and Jun 2006 underwent the operation of anterior cervical decompression,autograft fusion and cervical artificial disc replacement.Preoperative,immediate postoperative and follow-up X-ray films and JOA scores were ultilized to evaluate the fusion of planted bone,the stability of internal fixation and artificial disc,and the improvement of neurological deficit.Result：Preoperative neurological symptoms obviously alleviated or disappeared in most patients.According to JOA score,the ratio of improvement in neurological function was 52.5% including 7 excellent cases（46.7%）,5 good cases（33.3%）,2 fair cases（13.3%）,and 1 bad case （6.7% ）.During the mean follow-up of 13 months （3-24 months）,the time to reach bony fusion was 3-7 months （mean,4.5 months）,and no instrument failure were noted.There was no significant differences（P〉0.05） between preoperative movement （ 12.8±5.7° ） and postoperative movement （ 11.2°±5.4° ） at first year pest-operation.Conclusion： Anterior cervical decompression,autograft fusion and cervical artificial disc replacement is a rational and effective method for the surgical treatment of multi-level CSM.

关 键 词：脊髓型颈椎病 多节段 前路减压 非融合固定 人工椎间盘 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]