颈后前路联合一期手术治疗伴反弓的颈椎管狭窄症疗效分析  

COMBINED CERVICAL POSTERIOR-ANTERIOR OPERATION FOR TREATMENT OF CERVICAL SPINAL CANAL STENOSIS WITH REVERSE ARCH

作　　者：胡炜[1,2,3] 马信龙[4] 孙天威[2,3] 方钊[2,3] 张学利[2,3] 崔子健[2,3] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市人民医院 [3]南开大学人民医院脊柱外科 [4]天津医科大学总医院骨科

出　　处：《中国修复重建外科杂志》2013年第4期385-388,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨颈后前路联合一期手术治疗伴反弓的颈椎管狭窄症的临床疗效。方法 2009年5月-2012年2月,收治13例伴反弓的颈椎管狭窄症患者。其中男7例,女6例;年龄38～62岁,平均43.5岁。病程18～60个月,平均25个月。患者均存在颈部轴性症状及髓性症状;颈椎侧位CR检查可见颈椎反弓表现。椎间盘突出节段包括C3～6 4例,C4～7 4例,C3～7 5例。先俯卧位行颈后路单开门椎板成形术,再仰卧位行颈前路椎间盘切除、椎间融合器植入钛板内固定术。术后摄颈椎正侧位CR片观察颈椎曲线及内固定物有无松动;颈椎MRI观察颈脊髓压迫程度变化;手术前后采用疼痛视觉模拟评分(VAS)评价颈部轴性症状改善情况,采用日本骨科协会(JOA)评分标准评估神经功能改善情况。结果术后切口均Ⅰ期愈合。13例均获随访,随访时间9～32个月,平均15.4个月。内固定物位置良好,无松动、断裂;颈脊髓压迫程度较术前明显改善;术后6个月均获骨性融合。末次随访时,轴性症状与神经功能均较术前明显改善,VAS评分由术前(6.55±1.52)分降至(3.25±1.54)分,JOA评分由术前(7.05±1.32)分提高至(10.45±4.23)分,颈椎曲线由术前(3.22±5.15)mm提高至(6.53±3.12)mm,各指标手术前后比较差异均有统计学意义(P<0.05)。结论对于伴反弓的颈椎管狭窄症,颈后前路联合一期手术是一种安全有效的手术方法。Objective To evaluate the effectiveness of combined posterior decompression with laminoplasty and anterior decompression with fusion for the treatment of cervical spinal canal stenosis with reverse arch. Methods Between May 2009 and February 2012, 13 cases of cervical spinal canal stenosis with reverse arch underwent posterior decompression with laminoplasty surgery in prone position and then anterior decompression with fusion surgery in supine position. There were 7 males and 6 females with an average age of 43.5 years （range, 38-62 years） and an average disease duration of 25 months （range, 18-60 months）. All the patients had neck axial symptoms and spinal cord compressed symptoms, and lateral computer radiology （CR） of the neck showed reverse arch of cervical vertebrae. Segments of intervertebral disc protrusion included C3-6 in 4 cases, C4.7 in 4 cases, and C3-7 in 5 cases. After operation, anteroposterior and lateral CR was used to observe the cervical curvature change and fixation loosening, MRI to observe the change of the compression on spinal cord, visual analogue scale （VAS） score to evaluate the improvement of axial symptom, and Japanese Orthopaedic Association （JOA） score to assess the nerve function improvement. Results All incisions healed by first intention. All patients were followed up 9-32 months （mean, 15.4 months）. Internal fixator had good position without loosening or breaking and the compression on spinal cord improved significantly after operation. All the patients obtained bony fusion at 6 months after operation. The axial symptoms and the nerve function at last follow-up were improved. VAS score at last follow-up （3.25 土 1.54） was significantly lower than that at preoperation （6.55 土 1.52） （P 〈 0.05）; JOA score at last follow-up （10.45 土 4.23） was significantly higher than that at preoperation （7.05 土 1.32） （P 〈 0.05）; and cervical curvature value at last follow-up [（6.53 土 3.12） mm] was significantly higher than that at p

关 键 词：颈椎管狭窄症 内固定 脊柱融合术 椎板成形术 

分 类 号：R687.3[医药卫生—骨科学]