颈椎前外侧入路椎间孔扩大术治疗神经根型和椎动脉型颈椎病的初步临床报告  

Preliminary clinical report of anterolateral foraminotomy for the treatment of cervical spondylotic radiculopathy and vertebral arteriopathy

作　　者：菅凤增[1] 陈赞[1] 苏春海[1] 凌锋[1] 

机构地区：[1]首都医科大学宣武医院神经外科,中国国际神经科学研究所脊柱外科

出　　处：《中国现代神经疾病杂志》2009年第2期130-134,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的探讨颈椎前外侧入路手术治疗神经根型和椎动脉型颈椎病的方法及初步临床结果。方法6例单侧神经根型颈椎病、2例单纯椎动脉型颈椎病患者,手术前日本整形外科协会（JOA）评分平均15分。均于手术显微镜下施行颈椎前外侧入路钩椎关节切除及椎间孔扩大术。结果8例患者手术后临床症状即刻缓解。手术后3个月神经根型颈椎病患者CT和（或）MRI检查显示椎间孔减压良好,椎动脉型颈椎病患者CT和（或）CTA检查椎动脉减压良好;动态X线检查手术节段椎体活动度保留。JOA评分平均16.60分。随访6～47个月,无一例复发。结论颈椎前外侧入路手术可以直视神经根和椎动脉,能够获得最为理想的减压效果,且不破坏椎间盘的完整性,无需椎体间融合及内固定,可以保留椎间盘的功能及椎体间的活动度。Objective To explore the surgical technique and preliminary clinical result of anterolateral foraminotomy for the treatment of cervical spondylotic radiculopathy and vertebral arteriopathy. Methods From August 2004 to December 2007, 8 cervical spondylosis patients （6 cases of unilateral cervical spondylotic radiculopathy and 2 cases of simple cervical spondylotic vertebral arteriopathy） were treated surgically in our institute. The pre-operative mean Japanese Orthopedic Association （JOA） score was 15. Pre-operative CT demonstrated foramen stenosis or vertebral artery insufficiency caused by osteophyte from posterior margin of the vertebral bodies or uncovertebral joint in all the cases. All patients were treated by anterolateral uncover-tebral joint removal and foraminotomy under operativing microscope. Results Clinical symptoms were reieved instantly after operation in all 8 cases. At 3 months after surgery, CT and （or） MRI showed good decompression of intervertebral foramen in all patients of cervical spondylotic radiculopathy; CT and （or） CTA also showed satisfactory decompression of the vertebral artery in all patients of cervical spondylotic vertebral arteriopathy. The dynamical X-ray examination showed that cervical vertebral activity of the operated segments was retained in all cases. After operation, the mean JOA score was 16.60. Follow-up ranged 6-47 months, and there were no symptoms recurrence. Conclusion Anterolateral foraminotomy can offer a very good decompression by direct visualization of the spinal nerve roots and vertebral artery; at the same time, the integrity of the intervertebral disc can be preserved and bone implant and interbody fusion are not needed, hence, the function of the disc can be well preserved.

关 键 词：颈椎病 脊神经根 椎底动脉供血不足 减压术 外科 

分 类 号：R687.3[医药卫生—骨科学]