重度颈椎后凸畸形的手术治疗  

Surgical treatment for severe cervical kyphosis

作　　者：袁文[1] 刘洋[1] 陈德玉[1] 肖建如[1] 周许辉[1] 陈雄生[1] 王新伟[1] 陈华江[1] 贾连顺[1] 

机构地区：[1]第二军医大学长征医院骨科,上海200003

出　　处：《中华骨科杂志》2007年第9期671-676,共6页Chinese Journal of Orthopaedics

摘　　要：目的回顾性分析颈椎后凸畸形的外科治疗策略及临床疗效。方法1998至2005年间，16例重度颈椎后凸畸形（Cobb角平均为36^o）的患者接受手术治疗，颈椎后路椎板切除术后10例（7例多节段脊髓型颈椎病，3例脊髓型颈椎病合并后纵韧带骨化），青少年神经纤维瘤病合并后凸畸形2例，颈椎严重退变性后凸畸形2例，颈前路术后塌陷1例以及颈椎感染后畸形1例。手术策略分别为前路矫形与前后路联合矫形，对于畸形僵硬者辅以后路截骨，术中应用运动诱发电位（MEP）监测。术后通过影像学评估及JOA评分对手术效果进行评价。结果全部患者均得到随访，平均随访2．5年（2．0-5．8年）。影像学随访显示在术后1年均获得骨性融合，JOA评分由术前（10．5±1．8）分改善至术后（15．8±2．4）分（P〈0．01），末次随访（15．1±1、7）分。2例患者术后颈部疼痛加重，1例术后出现肩部疼痛，经对症保守治疗后症状均有所缓解；1例切口血肿，经过应用止血药、穿刺抽吸后好转，2周后血肿吸收。术后5例患者神经症状完全缓解，9例有不同程度地改善，2例与术前相比无明显变化。术后畸形明显改善，平均Cobb角-1．6^o，末次随访矫形维持较好。结论对于重度颈椎后凸畸形，术前仔细评估、选择恰当的手术策略、术中脊髓监测、较为熟练的外科技术均是获得良好疗效的前提条件，由于疾病本身病理生理改变及手术方式较为复杂，远期疗效有待于进一步观察。Objective To retrospectively analyze the surgical strategy of severe cervical kyphotic deformity and its clinical efficacy. Methods Between March 1998 and June 2005, 16 patients with severe cervical kyphotic deformity with mean 36 degree were surgical treated. The patients were classified to postlaminectomy （10 cases）, adolescent cervical kyphosis patients with neurofibromatosis（2 cases）, severe cervical degeneration （2 cases）, postoperation of anterior surgery （1 cases） and post-infection cervical kyposis （1 case）. Among the 10 postlaminectomy kyphosis patients, 7 were multilevel cervical myelopathy, 3 were cervical myelopathy combined with ossification of posterior longitudinal ligament （OPLL）. The surgical strategy was anterior correction or combined procedure in regards to different situations. To patients with rigid deformity, posterior cervical osteotomy was combined with. Motor evoked potential （MEP） was applied intraoperation as the spinal cord monitor. All patients were followed up with the mean time 2.5 years （range 2 to 5 years）, and evaluated by radiography assessment and JOA scoring. Results All patients had a solid fusion at follow-up evaluation after one year postoperation. JOA scoring was improved from preoperative 10.5±1.8 to postoperative 15.8±2.4 （P〈0.01）, and 15.1 ±1.7 at last follow-up. Postoperative complications included neck pain aggravation （2 cases）, postoperative shoulder pain （1 case）, whose were improved by conservative treatment. One case with wound hematoma healed after puncture and drainage. Neurologically, 5 patients were cured, 9 were improved and returned to premorbid function, 2 were stable, and 1 had unsatisfactory outcome. The deformities were improved significantly and the corrections maintained well in final follow-up. Conclusion These data suggest that preoperative careful evaluation, appropriate surgical strategy, intro-op- erative spinal cord monitor and skilled technique are essential for successful surgical treatment and

关 键 词：颈椎 脊柱后凸 截骨术 

分 类 号：R686[医药卫生—骨科学]