脊柱显微内镜下前路颈椎间盘切除植骨融合钢板内固定治疗颈椎病  

Anterior Micro endoscopic cervical discectomy with cervical interody fusion in the treatment of cervical spondylosis

作　　者：孟志斌[1] 黄涛[1] 付昆[1] 李俊[1] 李洪潮[1] 张英[1] 周建强[1] 纪志华[1] 

机构地区：[1]海南医学院附属医院骨科,海南海口570102

出　　处：《生物骨科材料与临床研究》2011年第5期4-7,共4页Orthopaedic Biomechanics Materials and Clinical Study

摘　　要：目的观察脊柱显微内镜经前路椎间减压椎间融植骨融合治疗颈椎病的临床疗效。方法自2006年6月~2011年6月共治疗单节段颈椎病患者31例。男15例,女16例,年龄36~78岁,平均49岁。患者术前表现不同程度的一侧肢体疼痛、麻木或乏力。31例患者均进行脊柱显微内镜下前路颈椎间盘切除减压、自体骨椎间植骨融合。主要观察指标:依据JOA评分系统评价患者神经症状的改善程度,手术后影像资料,含颈椎生理曲度、椎间隙融合情况等。结果所有患者均获得随访,随访时间3~36个月,平均18个月,31例患者均在脊柱显微内镜下顺利完成椎间植骨融合术,并行短节段颈椎前路钢板固定手术,手术时间80~225分钟,平均102±34分钟,手术出血40~180ml,平均80±30ml,术后住院时间6~10天,平均7天。手术后患者神经功能均有不同程度改善,按JOA脊髓功能评分:术前JOA评分为4~10分,平均7.4±0.12分,术后8~16分,平均13.8±0.17分,平均改善率﹙13.8-7.4﹚/﹙17-7.4﹚×100%=66.6%。治疗前后比较,差异有显著性﹙<0.01﹚。融合节段间棘突过伸过屈距离改变:术前3.4±0.3cm,术后3月2.5±0.24cm,术后6月1.9±0.18cm,治疗前后差别有显著统计意义﹙<0.01﹚,全部病例均达到椎间隙融合,融合率100%。1例术后C5左侧神经根支配区域麻痛,术后3周逐步减轻。未发生神经损伤、硬脊膜破裂、脑脊液漏、椎动脉损伤、术后血肿及感染、钢板螺钉折断、植骨块松动等并发症。结论脊柱显微内镜下前路颈椎前路减压更精确,椎间隙减压充分,能保留椎体终板结构,对保证手术后颈椎的植骨椎间融合,防止椎间融合后的塌陷有意义,可显著提高手术后的疗效。Objective To observe the clinical curative effect of cervical diseectomy with cervical interbody cancellous bone fusion under anterior spine microscopic endoscopy in the treatment of cervical spondylitic myelopathy. Methods From Jun 2006 to Jun 2011, 31 cases of short segment cervical spondylosis patients were treated, male 15 cases, female 16 cases, age 36-78 years old, average 49 years old. Patients show different degree of one side limb physical pain, numbness and paralysis preoperative. 31 cases are all performed anterior spinal microscopic endoscopic decompression by resection ＆the cervical intervertebral disc, then cancellous autogeneous hone interbody fusion. JOA scoring system based on patients evaluation of neurological symptoms improved after surgery, imagination data, including cervical physical curvature, fusion suituation. Results All patients were followed-up from 3 to 36 months （ average of 18 months ）, 31 patients were successfully completed micro-endoscopic spine interbody bone grafting fusion with short segment anterior cervical plate fixation. Operating time 80-225 minutes （ average 102± 34 minutes ）, operating hemorrhage 40-180ml （ an average of 80±30ml ）, postoperative hospital stay 6-10 day （ 7 days on average ）. Neural function of patients a^er surgery has different levels improved, spinal cord function by JOA scoring, JOA preoperative assessment is 4-10 （ averaging 7.4 ±0.12 ）, postoperative 8-16 （ averaging 13：8 i 0.17 ）, average improvement rate. （ 13.8 -- 7.4 ） /（ 17 -- 7.4 ）× 100%= 66.6%. There was significant differences （ P 〈0.01 ）before and after treatment. Spinous flexion and extension distance change between fusion segments was 3.4 ±0.34cm preoperatively, 2.5±0.24cm 3 month after operation, 1.9±0.18cm 6 month after operation,there were significant statistical difference （ P〈0.01 ）before and after operation and all cases had reached Intervertebral fus- ion, the fusion rate was 100%. 1 case of C5 nerve root on the left has domin

关 键 词：脊柱显微内镜 颈椎病 颈椎管减压 椎间植骨融合 

分 类 号：R687.3[医药卫生—骨科学]