颈前路植骨、内固定术治疗脊髓型颈椎病的疗效分析  

Therapeutic Effect of Anterior Fusion with Internal Fixation in Treatment of Cervical Spondylotic Myelpathy

作　　者：李强[1] 薄连洪 李威[2] 

机构地区：[1]天津市宁河县医院骨科,天津301500 [2]海军总医院骨科,北京100048

出　　处：《海军总医院学报》2009年第4期200-202,共3页Journal of Naval General Hospital of PLA

摘　　要：目的探讨脊髓型颈椎病颈前路的手术疗效及影响手术的相关因素分析。方法对36例脊髓型颈椎病患者行颈前路椎间盘切除减压术或椎体次全切自体髂骨植入结合颈前路钢板固定术。术前及随访时采用日本骨科学会17分法评估患者神经功能状况及术后疗效,并分析相关因素。结果34例患者获得随访,随访时间3个月至3年,平均15.2个月。手术后恢复满意,患者生活基本可自理。神经功能改善依据日本骨科学会评定标准,优4例,良18例,可13例,差1例;日本骨科学会17分法评分由术前(11.43±1.84)分上升至术后的(14.24±1.55)分,整体优良率为61.11%。术后改善率与病程、术前功能评分、磁共振显像有关。结论颈前路减压植骨融合内固定手术对脊髓型颈椎病治疗有效。一经确诊应及早手术处理,充分减压。颈髓磁共振显像T2高信号对脊髓型颈椎病预后判断有重要意义。Objective To explore the effect of surgical treatment of cervical spondylotic myelopathy through anterior decompression and internal fixation and to evaluate the thera- peutic effects and the correlation factors influencing the prognosis. Methods Thirty-six ca- ses of cervical spondylotic myelopathy were treated with cervical anterior decompression, self-ilium orbital implant combined with cervical anterior internal fixation with anterior cervical plate. Improvement of spinal cord function was assessed with the Japanese orthopaedic association （JOA17） scoring system, and the effect of operation and the influential factors were also analyzed. Results Thirty-four patients were followed up, and the mean follow-up time was 15.2 months （from 3 months to 36 months）. The postoperative treating effects were satisfactory and the patients could be basically self-cared. JOA criteria was used to eva- luatethe functional recovery of nerve：excellent in 4 case,good in 18 cases,medium in 13 cases,ineffective in 1 case. JOA score was improved from 11.43 ± 1.84 preoperatively to 14. 24± 1.55 postoperatively and the fineness rate was 61.11 ±. The recovery rate was related with course of disease,preoperative JOA score and MRI. Conclusion Anterior cervical decompression and fu- sion with fixation is an effective method for the treatment of cervical spondylotic myelopathy. The cases should be treated by surgery with full decompression as soon as a definite diagnosis of spondy- lotic myelopathy is established. Cervical intramedullary high intensity lesion on T2-weighted MR im- ages is significant for the estimation of clinical prognosis in cervical spondylotic myelopathy.

关 键 词：前路内固定 脊髓型颈椎病 手术治疗 

分 类 号：R681.5[医药卫生—骨科学]