双节段椎融合固定治疗颈椎间盘突出伴邻近节段不稳定  

Double Segment Vertebral Fusion and Fixation for Cervical Disc Herniation Associated With Adjacent Segment Instability

作　　者：贺永雄[1] 刘斌[1] 王东升[1] 东家茂[1] 包昌盛[1] 刘聪[1] 玉海[1] 张连生[1] 王永东[1] 彭云生[1] 刘宝江[1] 

机构地区：[1]内蒙古医科大学附属人民医院骨科,内蒙古呼和浩特010030

出　　处：《内蒙古医学杂志》2013年第3期298-302,共5页Inner Mongolia Medical Journal

摘　　要：目的：探讨双节段椎融合固定治疗颈椎间盘突出伴邻近节段不稳定的临床疗效。方法：回顾性分析了2011年3月～2012年6月收治的颈椎单节段颈椎间盘突出伴邻近一个节段不稳患者18例。男12例，女6例，所有病例均为颈椎双节病变，临床表现为脊髓受压伴交感神经症状，病变在C4／5、C5／6节段10例，C3／4，C4／5节段3例，C5／6，C6／7节段5例。对病变双节段行前路经椎间隙减压固定融合术，术中对影像学上表现为椎间盘突出的病例均彻底切除病变椎间隙处后纵韧带，邻近不稳定节段只做间盘切除处理，不干扰后纵韧带；评估比较术前、术后1周及末次随访时临床症状及影像学情况，采用日本骨科协会（JOA）17分法和交感神经症状20分法和作为临床疗效评价标准，随访记录脊髓神经功能和交感神经症状改善情况；根据x线片评价植骨融合情况。结果：18例患者切口愈合良好，无神经和血管损伤，脑脊液漏。所有患者均获得随访，随访时间6个月～18个月，平均为12个月。JOA评分术前8．8±2．0分，术后1周12．6±2．2分，末次随访13．0±2．2分。术后1周、末次随访与术前比较差异均有统计学意义（P〈0．05），交感神经症状评分术前8．8±2．3分，术后1周1．8±2．0分，末次随访时2．0±1．8分，患者主观满意率84％；术后1周、末次随访与术前评分比较差异有统计学意义（P〈0．05）。术后1周与末次随访时JOA评分和交感神经症状评分差异均无统计学意义（P〉0．05）。末次随访时x线片显示手术节段椎间隙植骨全部融合，颈椎内固定无脱落、断裂，椎间高度维持良好。结论：颈椎前路双节段植骨融合内固定术是治疗颈椎间盘突出伴邻近节段不稳定的有效方式。Objective： To investigate the clinical efficacy of the double segment vertebral fusion and fixation in treating cervical disc herniation associated with adjacent segment instability. Methods：Retrospectively analyze 18 patients with single segment cervical disc herniation associated with an unstable neighboring segment, admit- ted from March 2011 to June 2012. Twelve were male and six were female. All the cases were cervical double lesions, and clinical manifestations were spinal cord compression associated with sympathetic symptoms, 10 cases were lesions in CA / 5 and C5 / 6 segments, three cases in C3＇ / 4 and C4 / 5, and five cases in C5 / 6 and C6 / 7. Anterior passing intervertebral decompression, fixation and fusion of the intervertebral space were conduct- ed to treat double segment lesion. The diseased intervertebral space at the posterior longitudinal ligament was completely removed during the surgery from disc cases which showed in imaging. The neighboring unstable seg- ment was only treated with between - disk excision, without interfering with the posterior longitudinal liga- ment. Clinical symptoms and imaging situation during the one week preoperative, one week postoperative and the last follow - up were compared and evaluated. Japanese Orthopaedic Association＇s （JOA） 17 points method and sympathetic symptoms 20 points method were adopted as the clinical efficacy evaluation criteria. Improve- ment of spinal cord nerve function and of sympathetic symptoms was recorded during the follow- up. Interbody fusion was evaluated based on X- rays. Results： 18 patients with incision healed well, without neurological and vascular injury, or cerebrospinal fluid leakage. All patients were followed up for 6 months to 18 months, that is, 12 months on average. Preoperative JOA score was 8.8± 2.0 points, 12.6 ± 2.2 one week postoperative, and 13.0 ±2.2 in the last follow - up. The situations during the one week preoperative, one week postoperative and the last follow- up were statistically different�

关 键 词：颈椎间盘突出 邻近节段不稳 双节段 前路内固定 

分 类 号：R681.5[医药卫生—骨科学]