前后路联合手术治疗脊髓型颈椎病的适应证探讨  

Evaluation of the indications of anterior-posterior approach for cervical spondylotic myelopathy（CSM）

作　　者：马巍[1] 张党峰[1] 吴学元[1] 

机构地区：[1]西安交通大学医学院第一附属医院骨科,710061

出　　处：《美中国际创伤杂志》2007年第2期12-15,共4页U.S.Chinese International Journal of Traumatology

摘　　要：目的：探讨前后路联合手术在脊髓型颈椎病中的适应证。方法：对87例脊髓型颈椎病合并多节段颈椎管狭窄、后纵韧带钙化（0PLL），合并颈椎黄韧带肥厚或黄韧带钙化症，多节段颈椎间盘后突压迫或椎体后缘巨大骨赘者，颈椎退变性节段不稳伴颈椎、脊柱后凸畸形患者行前后路联合减压、植骨融合、内固定手术。结果：87例患者随访10～24个月（平均12，6个月），植骨均已融合，内固定物无松动、断裂。根据日本矫形外科学会（JOA）评分标准，除5例高位完全截瘫患者未恢复外，其余82例患者平均JOA评分由术前8．9分（5～11分）增加到13，2分（8～17分），评分提高3～6分。术后短期并发症均逐渐恢复；4例食管瘘患者经手术修补也顺利愈合。结论：前后联合手术减压充分，能较好重建颈椎稳定性。适用于脊髓型颈椎病合并多节段颈椎管狭窄、后纵韧带钙化（0PLL），合并颈椎黄韧带肥厚或黄韧带钙化症，多节段颈椎间盘后突压迫或椎体后缘巨大骨赘者，颈椎退变性节段不稳伴颈椎后凸畸形患者等。To evaluate the indications of anterior-posterior approach for cervical spondylotic myelopathy （CSM）. Methods： 87 cervical spondylosis myelopathy patients with multilevel cervical spinal stenosis, ossification of the posterior longitudinal ligament （OPLL）, hypertrophic ligamentum flavum,compression or big osteophyma lying in the posterior margin of vertebral body, cataplasia or unsteadiness together with kyphosis etc., underwent anteriorposterior decompression, bone grafting fusion and internal fixation. Results： All cases were followed up for 12.6 months （ranging, 10-24 months）. Fusion was noted in all patients. No loosening or breakage of internal fixator was found. According to criteria of Japan orthopedic Association（JOA）, preand post-operative JOA scores were 8.9 （5～11） and 13.2 （8～17） respectively in all cases except 5 complete paralyzed patients, （mean 3～6 scores）. Short-term complications all recovered gradually. 1 case of esophageal fistula was healed after secondary esophagoplasty. Conclusion： Anterior-posterior approach can provide satisfactory decompression and rigid stabilization to cervical spine, which is a highly viable option to complex cervical disorders. It can be used for cervical spondylosis myelopathy patients with multilevel cervical spinal stenosis, ossification of the posterior longitudinal ligament （OPLL）, hypertrophic ligamentum flavum,compression or big osteophyma lying in the posterior margin of vertebral body; cataplasia or unsteadiness together with kyphosis and so on.

关 键 词：脊髓型颈椎病 外科手术 颈椎后凸 多节段 前后路联合手术 

分 类 号：R681.55[医药卫生—骨科学]