3种手术方式治疗脊髓型颈椎病的疗效分析  

Three surgical methods in the treatment of cervical spondylotic myelopathy

作　　者：王金堂[1] 李天清[1] 李萌[1] 贾光辉[1] 聂治军[1] 武世勋[1] 

机构地区：[1]西安交通大学医学院第一附属医院骨科,陕西西安710061

出　　处：《临床骨科杂志》2009年第2期124-126,共3页Journal of Clinical Orthopaedics

摘　　要：目的分析脊髓型颈椎病(CSM)前路3种手术方式的疗效。方法150例脊髓型颈椎病患者采用前路减压+植骨融合术45例(A组)、前路减压+cage融合术30例(B组)、前路减压+钛网内植骨+钢板内固定术75例(C组)。术后3 d及6、12、24周摄颈椎正、侧位X线片。JOA评分系统评定不同手术方法的疗效。结果150例均获随访,时间6～60个月。除1例未融合外,余植骨均融合,时间为2～4个月。JOA评分均有改善,A组改善率为72.8%,B组为85.6%,C组为80.6%,B组与C组比较差异无显著性(P>0.05),B组和C组与A组比较差异有显著性(P<0.05)。结论CSM的治疗关键在于充分减压及有效植骨融合,减压加椎间融合器植入术具有操作简单、出血少、减压充分、术后恢复好等优点,是治疗脊髓型颈椎病的较好方法。Objective To analyze the effects of the three surgical methods in the treatment of cervical spondylotic myelopathy （ CSM）. Methods 150 cases of patients with cervical spondylotic myelopathy were performed with three kinds of surgeries： 45 anterior cervical decompression and fusion only with bone graft（ group A） ,30 anterior cervical decompression and fusion with cage（ group B） , and 75 anterior cervical decompression and bone graft in the Titanium mesh and fusion with anterior screw-plate system（ group C）. Cervical spine X-ray were taken in 3 days,6 weeks and 12,24 weeks after the operation. Improvement rate of JOA was used to evaluate the clinical outcomes. Results 150 patients were followed up for 6 to 60 months. 149 cases had good fusion except one, the average fusion time was 2 4 months. All patients had JOA improvement after surge17. The improvement rate of group A was 72.8% ,group B 85.6% and group C 80. 6%. There was no significant difference （ P 〉 0.05 ） between group B and group C, while both the group B and the group C were significant different with the group A （ P 〈 0. 05 ）. Conclusions The key points in the treatment of CSM are thorough decompression and effective fusion. The surge17 of anterior cervical decompression and fusion with cage method is a good method in the treatment of CSM because it is simple with less bleeding, full decompression and satisfactory postoperative recovery.

关 键 词：脊柱融合术 植骨 内固定 颈椎病 

分 类 号：R681.53[医药卫生—骨科学] R687.3[医药卫生—外科学]