一期后路单开门联合前路选择性减压融合术治疗多节段脊髓型颈椎病  

One-stage Expansive Open-door Laminoplasty and Selective Anterior Decompression and Fusion for Multilevel Cervical Spondylotic Myelopathy

作　　者：黄勇全[1] 刘先明[1] 黄华伟[1] 陈文明[1] 

机构地区：[1]萍乡市人民医院骨一科,江西萍乡337000

出　　处：《南昌大学学报（医学版）》2012年第11期52-55,共4页Journal of Nanchang University：Medical Sciences

摘　　要：目的评估一期后路单开门联合前路选择性减压治疗多节段脊髓型颈椎病的手术疗效。方法对46例多节段(≥3节段)脊髓型颈椎病患者,均行后路单开门椎管成形+前路选择性椎体次全切除和(或)椎间盘切除椎间钛网、Cage或髂骨块植骨+前路钢板内固定术。术后测量颈椎曲度角评价颈椎排列,采用日本矫形外科学会(jap-anese orthopaedic association,JOA)评估系统评价其功能恢复情况,采用正侧位、动力位X线摄片和三维CT重建方法评估融合程度。同时,进行MRI检查,以观察脊髓减压程度和脊髓情况。结果所有病例均获得平均24.1(12～28)个月的有效随访。JOA评分:术前为(9.0±1.2)分,术后6个月为(13.9±0.7)分,与术前比较,差异有统计学意义(P=0.007);末次随访为(14.1±0.6)分,与术前比较,差异有统计学意义(P=0.004)。颈椎曲度角术前为(34.7±4.1)°,术后6个月为(37.1±5.1)°,术后6个月曲度角与术前比较,差异有统计学意义(P=0.024)。术后12个月和末次随访,所有病例均已达到骨性融合,且椎管减压明显。结论一期后路单开门联合前路选择性减压融合术是治疗多节段脊髓型颈椎病一种安全、有效的方法,在达到充分解除脊髓前后压迫的同时恢复颈椎排列,提高植骨融合率。Objective To evaluate the curative efficacy of one-stage expansive open-door laminoplasty combined with selective anterior decompression and fusion in multilevel cervical spondylotic myelopathy.Methods Forty-six patients with multilevel cervical spondylotic myelopathy（≥3 consecutive segments） were treated with expansive open-door laminoplasty,selective anterior corpectomy,and（or） cervical reconstruction with titanium mesh cages,iliac bone graft,and anterior rigid plate fixation.The cervical curvature was determined to evaluate cervical spine arrangement.The functional recovery was assessed by japanese orthopaedic association（JOA） scoring system.The degree of fusion was estimated by eutopic and lateral dynamic X-ray radiography and three-dimensional CT reconstruction.The degree of spinal cord decompression and spinal cord situation were determined by MRI.Results All patients were followed-up for an average of 24.1 months（range 12 to 28 months）.JOA scores were significantly improved from preoperative 9.0±1.2 to 13.9±0.7 at 6 months after operation（P=0.007） and 14.1±0.6 at the final follow-up（P=0.004）.Cervical curvature was improved from preoperative（34.7±4.1）°to（37.1±5.1）°at 6 months after operation（P=0.024）.At 12 months after operation and final follow-up,all patients achieved bony fusion and spinal canal decompression.Conclusion One-stage posterior-anterior decompression and fusion is safe and effective,and can relieve spinal cord compression,restore cervical arrangement and promote bone fusion in the treatment of multilevel cervical spondylotic myelopathy.

关 键 词：脊髓型颈椎病 植骨融合术 椎板成形术 手术入路 

分 类 号：R681.55[医药卫生—骨科学]