双钢板在颈前路手术中的应用  

Application of double plates in the anterior approach for cervical spondylotic myelopathy (CSM)

作　　者：张海龙[1] 傅强[1] 葛星野[1] 赵鑫[1] 陈元贵[1] 尚保华[1] 侯铁胜[1] 

机构地区：[1]第二军医大学长海医院骨科,上海市长海路168号200433

出　　处：《中国矫形外科杂志》2008年第5期325-327,共3页Orthopedic Journal of China

摘　　要：[目的]探讨“跳跃型”多节段脊髓型颈椎病行颈前路双钢板固定的应用价值。[方法]本院2003年7月～2004年7月对21例“跳跃型”多节段脊髓型颈椎病及7例脊髓型颈椎病再次手术患者行颈前路单间隙切除＋单间隙切除（椎体次全切）＋自体髂骨植骨、双钢板内固定术。术后6、9、12个月随访摄片，对其症状缓解、植骨融合、内固定及并发症情况进行观察。[结果]所有患者获得16—32个月（平均24个月）的随访。根据JOA评分，患者平均改善率为88．5％；术后6个月融合率为82．1％，9个月融合率为89．3％，术后12个月融合率为93％；无患者死亡，供骨区并发症6例。此术式手术适应证：适用于病理压迫位于脊髓前方的患者，包括中央型、广基的椎间盘突出、邻近或位于椎间盘的较大桥接骨赘，尤其适用于非颈椎前凸的“跳跃型”多节段脊髓型颈椎病患者。并发症：通常与解剖过程中软组织的损伤及神经受损有关，另外，亦可发生远期内固定与融合失败。[结论]“跳跃型”多节段脊髓型颈椎病及脊髓型颈椎病再次手术患者行颈前路双钢板固定，可获得较满意的临床疗效。可以重建椎管容积以及椎间孔的高度，有效解除脊髓前方所受的压迫；对于伴有颈椎后凸畸形的颈椎病患者，既能前路减压又能重建颈椎生理前凸。[ Objective] To investigate the value of double plates in the anterior approach for the treatment of jumping multilevel CSM. [Method] From July 2003 to July 2004, 21 eases of jumping multilevel CSM and 7 eases of CSM were operated with single level diseeetomy/anterior eorpeetomy and self-iliae bone graft and fixation by double plates. During the 6, 9, 12 month follow-up, bone fusion were assessed and neurologieal funetion, complieations were reeorded. [ Result ] All patients were followed up for 16 -32 months （24 months on average）. Based on JOA evaluation, the average improving rate was 88.5%. And 82. 1% fusion was aehieved at 6 months, the fusion rate reaehed 89. 3% and 93% at 9 and 12 months aeeordingly. There were 6 eases with complications in the donor site of grafting. Indications of this approach： the compressing pathology was located anterior to the spinal cord. This ineluded eentral, broad-based dise herniations and large bridging osteophytes at or edjaeent to the level of the dise spaee. And it was espeeially indieated for patients with jumping multilevel CSM who did not have a lordotie spine. Complieations： complieations oceurring with this approaeh eould be related to injuries to the soft tissue during disseetion or to the neurologieal elements. In addition, postoperative fusion or hardware failure could oceur. [ Conclusion] Single level diseeetomy/anterior eorpeetomy and self-iliae bone graft and fixation by double plates is an effeetive treatment to the jumping multilevel CSM. It allows restoration of the spinal canal and neural foramen to normal dimensions to decompress the spinal cord. To the eases of jumping multilevel CSM that have a kyphotie deformity, it allows anterior decompression and reeonstruetion of the spine to help restore a lordotic curvature.

关 键 词：脊髓型颈椎病 前路手术 带锁钢板 

分 类 号：R687.3[医药卫生—骨科学]