自体棘突椎间植骨在颈椎一期后前路联合手术中的应用  

Effects of Spinous Process in Interbody Fusion in One-stage Anterior and Posterior Decompression for Cervical Spondylotic Myelopathy

作　　者：黄健曦[1] 高梁斌[1] 张亮[1] 张志[1] 黄文东[1] 林学扬[1] 

机构地区：[1]广州医学院第三附属医院脊柱外科,广东省广州市510150

出　　处：《中国骨与关节损伤杂志》2010年第11期961-964,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨一期后前路手术治疗钳夹型脊髓型颈椎病,后路切除的棘突在颈椎前路手术中的应用价值。方法回顾性分析采用一期后路单开门椎管成形术、前路椎间盘切除、椎间自体棘突植骨、钛板内固定术治疗钳夹型脊髓型颈椎病57例,随访分析术前和术后神经功能JOA评分,影像学测量患者C6、C7棘突的长、宽、高及植入后椎间高度的变化情况。结果影像学测量C6、C7棘突的大小符合椎间植骨块的要求,随访1年~6年,平均32个月,JOA评分由术前（7.6±2.8）分提升至（14.7±1.6）分,JOA评分改善率75.5%。随访X线片显示75个节段全部获得椎间融合,椎间高度有不同程度的恢复,随访无椎间高度丢失,未见植骨块塌陷移位或脱入椎管,无钛板、螺钉松动及再＂关门＂现象。结论颈椎一期后前路手术中,自体棘突可为前路椎间融合的理想植入物,避免取髂骨的并发症,减少了手术创伤。Objective To investigate the effects of the spinous process which was cut off in the posterior single open-door laminoplasty for interbody fusion in the one-stage anterior and posterior depression for cervical spondylotic myelopathy（CSM） patients.Methods Dur-ing 2003 to 2009,57 cases of CSM were treated by one-stage posterior single open door laminoplasty and anterior cervical discecomy and fusion and internal fixation by anterior plate.The interbody implant was the spinous process which was cut off in the posterior procedure.Japanese Orthopedic Association scoring system（JOA）was used to evaluate the improvement of neurological function,and the length,width,and height of spinous process of C6 and C7 were measured on X-ray.Also the intervertebral heights were measured by X-ray photographs of lateral cervical vertebraepre-and post-operatively.Results The length,width,and height of spinous process of C6 and C7 were（25.07± 4.32）mm,（5.62±1.76）mm,（7.44±1.56）mm and（35.37±4.64）mm,（7.51±1.72）mm,（9.02±1.46）mm,respectively.The mean follow up was 32 months（1 to 6 years）.JOA score was improved from 7.6±2.8 to 14.7±1.6（P0.05）,The recovery rate was 75.5%.The postoperative inter-vertebral height was higher than before operation,there was no loss in the last follow up.All 75 surgery segments got fusion,no graft col-lapse,internal fixation failure and door re-closure.Conclusion In one-stage anterior and posterior depression for CSM patients,the spinous process which is cut off in the posterior procedure can be used as the interbody implant for spinal fusion.It can avoid the compli-cations of taking ilium and reduce the surgical trauma.

关 键 词：脊髓型颈椎病 棘突 植骨融合 

分 类 号：R681.55[医药卫生—骨科学]