后路选择性扩大减压、侧块螺钉内固定治疗伴有曲度后凸的多节段颈椎病  

Selective posterior enlarged decompression and lateral mass screw fixation for mnltisegmental cervi- cal spondylotic myelopathy with kyphosis

作　　者：杜伟[1] 申勇[1] 张英泽[1] 丁文元[1] 王林峰[1] 

机构地区：[1]河北医科大学第三医院脊柱骨科,石家庄050051

出　　处：《中华骨科杂志》2013年第2期111-116,共6页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金资助项目（81071510）

摘　　要：目的探讨后路选择性扩大减压、侧块螺钉内固定治疗伴有曲度后凸的多节段颈椎病的疗效及并发症预防。方法2008年1月至2011年1月，采用颈椎后路手术治疗的患者43例，年龄42-74岁，平均59．6岁。手术前后采用13本骨科协会评分（JapaneseOrthopaedicAssociationScores，JOA）判定神经功能，颈椎功能残障指数量表（neckdisabilityindex，NDI）评价颈肩轴性痛程度，Ishihara法测定颈椎曲率指数（cervicalcurvatureindex，CI），在MRI上测量脊髓扩大和后移程度。结果43例患者手术平均减压（3．91±0．86）个节段（3-5个节段）。全部病例平均随访38个月（20-60个月）。术后3～6个月复查时颈椎植骨完全融合。术后JOA评分为（14．31±1．33）分，较术前（8．16±1．11）分有明显改善，临床效果优良率为95．34％。术后CI为15-30％±3．18％，较术前7．36％±9．69％有明显改善。术后颈椎中立位MRI显示最狭窄处硬膜囊前后径为（6．10±0．89）mm较术前（2．92±1．49）mm明显增加，较术前增加了108．9％。颈脊髓平均向后漂移（4．59±1．20）mm（2．97～6．68mm）。术后NDI评分为（4．90±2．46）分，较术前（19．36±8．61）分有明显改善。随访期间均未出现C5神经根麻痹，无内固定松动、脱出、断裂等并发症发生。结论后路选择性扩大减压、侧块螺钉内固定术治疗伴有曲度后凸的多节段颈椎病，能有效地改善神经功能，恢复和维持颈椎正常曲度，降低轴性症状和CS神经根麻痹发生率。Objective To investigate the effect and prevention of complications of selective posteri- or enlarged decompression and lateral mass screw fixation for multisegmental cervical spondylotic myelopa- thy with kyphosis. Methods From January 2008 to January 2011, 43 patients with multisegmental cervical spondylotic myelopathy combined with kyphosis, aged from 42 to 74 years （average, 59.6 years）, underwent selective posterior enlarged decompression and lateral mass screw fixation. The JOA （Japanese Orthopaedic Association） scoring system and Neck Disability Index （NDI） were applied to evaluate the neurological func- tion and axial neck/shoulder pain before and after surgery, respectively. The Ishihara method was employed to measure the cervical curvature index （CI）. The expanding and shifting of the spinal cord was calculated in MRI. Results The decompression range was 3 to 5 segments （average, 3.91±0.86 segments）. All patients were followed up for 20 to 60 months （average, 38 months）. There were significant differences between pre- and post-operative JOA score （8.16±1.11 vs. 14.31±1.33）, CI （7.36%±9.69% vs. 15.30%±3.18%）, anteropos- terior diameter of the dural sac at the level of maximum stenosis in MRI [（2.92±1.49） mm vs. （6.10±0.89） mm], and NDI score （19.36±8.61 vs. 4.90±2.46）. The mean spinal cord posterior shift was （4.59±1.20） mm （range, 2.97 to 6.68 mm）. The complete bone graft fusion was achieved in all patients 3 to 6 months after surgery. No C5 nerve root palsy or instrument failure occurred. Conclusion The selective posterior enlarged decompression and lateral mass screw fixation is effective in treating muhisegmental cervical spondylotic myelopathy with kyphosis, which can improve neurological function, recover and maintain the normal cervi- cal curvature, and decrease the incidences of axial symptoms and C5 nerve root palsy

关 键 词：颈椎 脊髓压迫症 脊柱后凸 

分 类 号：R687.3[医药卫生—骨科学]