颈前路植骨块过高对颈椎曲度及轴性症状的远期影响  

LONG-TERM EFFECT OF EXCESSIVE LENGTH OF BONE GRAFT VIA ANTERIOR CERVICAL APPROACH ON CERVICAL CURVATURE AND AXIAL SYMPTOM

作　　者：孟宪中[1] 曹俊明[1] 申勇[1] 孟宪国[1] 杨大龙[1] 杨柳[1] 

机构地区：[1]河北医科大学第三医院脊柱外科,石家庄050051

出　　处：《中国修复重建外科杂志》2009年第8期899-903,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的评价颈前路术中植骨块过高,椎间隙过度撑开对颈椎曲度及术后颈部轴性症状(axial symp-tom,AS)的远期影响。方法2001年6月-2004年6月,采用颈前路减压、自体髂骨植骨、钛板内固定治疗神经根型颈椎病患者30例。男14例,女16例;年龄32～73岁,平均54.7岁。病程1～31个月,平均7个月。病变节段均为C5、6。颈椎动力位X线片检查示无颈椎不稳。根据术后即刻测量椎间高度将患者分为两组:植骨块过高、椎间隙过度撑开为过撑组(11例),椎间高度较术前增加>3mm;植骨块高度合适、对椎间隙无过度撑开为无过撑组(19例),椎间高度较术前增加<3mm。术后1周,3、24、48个月定期摄X线片随访,分析患者术后植骨块骨性融合情况及融合节段椎间高度的变化、颈椎生理曲度的改变情况,并参照曾岩等拟定的颈部AS评定标准,对两组患者术后颈部AS进行观察。结果无过撑组无并发症发生;过撑组1例术后出现C5神经根麻痹,经积极治疗术后3个月逐渐恢复。30例患者均获随访,随访时间48～66个月,平均54.5个月。术后两组患者症状均明显缓解。除无过撑组1例术后12个月植骨未融合,余均于术后3～6个月植骨达骨性融合,无钢板和螺钉松动或断裂,无植骨块移位。术后48个月无过撑组椎间高度较术前增加(1.9±1.8)mm,过撑组增加(3.5±2.7)mm,两组比较差异无统计学意义(P>0.05)。颈椎手术固定节段生理曲度均维持良好,末次随访时无过撑组较术前增加(2.17±1.83)°,过撑组增加(3.32±2.71)°,两组比较差异无统计学意义(P>0.05)。颈椎整体生理曲度末次随访时无过撑组较术前增加(4.57±3.71)°,过撑组较术前减少(2.43±2.13)°,两组比较差异有统计学意义(P<0.05)。术后48个月颈部AS发生情况:过撑组优3例,良2例,可5例,差1例,AS发生率为54.55%;无过撑组优11例,良5例,可3例,AS发生率为15.79%;两组比较差异有统计学意义(P<0.05)。结论颈前Objective To evaluate the long-term effect of excessive length of bone graft via anterior cervical approach and over distraction of intervertebral space on cervical curvature and postoperative neck axial symptom （AS）. Methods From June 2001 to June 2004, 30 patients with nerve root cervical spondylosis at the C5、6 level underwent anterior cervical decompression, autogenous iliac bone graft and internal fixation with titanium plate. There were 14 males and 16 females aged 32-73 years old （average 54.7 years old）, and the course of disease was 1-31 months （average 7 months）. No instability of cervical vertebrae was noted on the cervical dynamic position x-ray films. Intervertebral height was measured immediately after operation, and accordingly the patients were divided into two groups： the over distraction group （n=11）, in which the length of bone graft was excessive, the intervertebral space was over distracted, and the intervertebral height was increased by more than 3 mm compared with the preoperative value; the proper distraction group （n=19）, in which the length of bone graft was proper, no over distraction of the intervertebral space occured, and the intervertebral height was increased by less than 3 mm compared with the preoperative value. Regular X-ray exams were performed i week and 3, 24, and 48 months after operation to analyze bone fusion condition of the grafted bone, changes of the intervertebral height of the fused segments, and variation of physiological curvature of the cervical vertebra. The postoperative neck AS was evaluated according to the the neck AS evaluation criteria set by ZENG Yan and co-workers. Results All patients were followed up for 48-66 months （average 54.5 months）. Clinical symptoms were eliminated in all cases. No complications occurred in the proper distraction group; 1 patient of the over distraction group had postoperative nerve root paralysis at C5 level, and recovered 3 months after proactive treatment. Bone fusion was achieved in all patients 3

关 键 词：颈椎病 颈前路植骨术 过度撑开 轴性症状 生理曲度 

分 类 号：R687.3[医药卫生—骨科学]