颈椎分期前后路手术的临床应用及疗效评价  

Two-staging surgical treatment for cervical spinal cord compression

作　　者：连小峰[1] 李浩[1] 徐建广[1] 刘小康[1] 赵成[1] 曾炳芳[1] 赵杰[2] 侯铁胜[3] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海202433 [2]上海交通大学医学院附属第九人民医院骨科 [3]第二军医大学附属长海医院骨科

出　　处：《脊柱外科杂志》2013年第1期28-31,共4页Journal of Spinal Surgery

摘　　要：目的探讨颈椎分期前后路手术的临床应用并评价其疗效。方法回顾分析2007年1月～2010年1月,分二期手术的颈椎伤病患者32例,其中26例为一期前路二期后路,6例为一期后路二期前路,2次手术时间间隔为3～12个月。结果所有患者随访24～48个月,平均32个月。根据美国脊髓损伤协会(American Spinal Injury Asso-ciation,ASIA)评分,患者一期术后神经功能较术前有明显改善(P<0.05),二期术后仍有明显改善(P<0.05);主观满意率由一期术后的56.3%提高到二期术后的75%。所有患者均获骨性融合。颈椎生理曲度由术前平均12.8°纠正到一期术后的18.5°(P<0.01),二期术后变化不明显,随访角度无明显丢失。结论对于颈椎前后压迫较重的患者,分期前后路手术是一种安全有效的方法,可为临床提供一种手术方案选择。Objective To treat cervical spinal cord compression surgically with two-staging different approaches and evaluate it＇ s outcomes. Methods A total of 32 cases with cervical spinal cord compressed severely treated from January 2007 to January 2010 were retrospectively reviewed. Twenty-six patients were performed anterior surgery at first stage and posterior surgery at secondly, and another 6 patients were surgically treated with posterior approach firstly and anterior approach seeondly. The interval between 2 surgical procedures was from 3 to 12 months. Results All cases were followed up for 24-48 months （mean 32 months）. According to American Spinal Injury Association （ASIA） scoring, the values ＂after first operation and the second operation elevated significantly respectively. And the satisfactory ratio was raised from 56.3% ＇after first operation to 75% after the second operation. All cases obtained bony fusion at 4.3 months postoperatively, and the kyphotic eurve was rectified from 12.8.to 18.5.after first operation. After second operation, there was no significant change. And at final follow-up, the rectification didn＇ t lost significantly. Conclusion For the patient with spinal cord circumferential compressed severely, two-staged surgical strategy is an effective and rational method, It can provide a surgical option for spine surgeon.

关 键 词：颈椎 脊髓压迫症 减压术 外科 骨移植 脊柱融合术 内固定器 

分 类 号：R681.531[医药卫生—骨科学]