颈椎前路减压植骨融合术后的脊髓前移  

Anterior migration of spinal cor d after anterior cervical decompression and reconstruction for cervical spondylosis

作　　者：钱宇[1] 何磊 赵晓峰[1] 张军[1] 

机构地区：[1]绍兴市人民医院骨科,312000

出　　处：《中华骨科杂志》2013年第10期997-1003,共7页Chinese Journal of Orthopaedics

基　　金：国家自然基金（81271974）,浙江省自然科学基金（Y2110653）

摘　　要：目的探讨颈椎前路减压植骨融合术后的脊髓前移现象及发生机制。方法回顾性分析2008年1月至2011年3月，采用颈椎前路减压重建手术治疗并获得完整随访的81例颈椎病患者资料，男44例，女37例；年龄37－72岁，平均52.3岁；脊髓型颈椎病70例，神经根型颈椎病11例。81例患者中行椎体次全切除术31例，椎间盘切除术50例。在术前及术后6个月颈椎MRI上测量脊髓前缘与椎管后壁距离（Da）和脊髓中点与椎管后壁距离（Dm）等参数，评估颈脊髓向前移位距离及其程度。采用日本矫形外科学会（Japanese Orthopaedic Association，JOA）评分，观察患者改善率。结果所有患者均获得随访，随访时间9-48个月，平均20．7个月。MRI上测量脊髓前缘与椎管后壁距离、脊髓中点与椎管后壁距离，术前脊髓前缘与椎管后壁距离与脊髓中点与椎管后壁距离分别为（11．11±1．59）nlm与（6．30±0．84）mm，与术后6个月的脊髓前缘与椎管后壁距离（11．63±1．47）mm与脊髓中点与椎管后壁距离（6．62±0．80）mm相比，差异均有统计学意义。术后6个月，除C2-3水平外，在C3-4C4-5C5-6C6-7各椎间隙水平，脊髓前缘与椎管后壁距离与脊髓中点与椎管后壁距离均较术前有所改善。共35例在手术减压节段ADa〉2mm或ADm〉1．3mm，占43．2％（35／81）。术前颈椎曲率指数为10．0％±6.3％，术后6个月为13．5％±6．5％，二者比较差异有统计学意义。JOA评分从术前的（9．7±1．5）分提高到术后1周的（13．7±1．1）分及术后6个月的（13．9±1．3）分。15例患者在术后6个月的JOA评分较术后1周下降，其中14例MRI测量达到脊髓显著前移标准。余无一例发生严重术后并发症。结论颈椎前路减压重建术后存在脊髓前移的现象，脊髓前移可能导致脊髓二次压迫。Objective To investigate anterior migration of spinal cord after anterior cervical decompression and reconstruction for cervical spondylosis and its mechanism. Methods Eighty-one patients with cervical spondylosis who underwent anterior decompression and reconstruction were reviewed and evaluated retrospectively. There were 44 males and 37 females, with an average age of 52.3 years （range, 37-72 years）. The distance from anterior margin of the spinal cord to posterior wall of the spinal canal （Da）, and medium of the spinal cord to posterior wall of the spinal canal （Din） in magnetic resonance imaging were measured preoperatively and postoperatively. The recovery rate was calculated comparing the Japanese Orthopaedic Association （JOA） scores before and after operation. Results The average following up was 20.7 months （9-48 months）. According to the measure on MRI, preoperative Da and Dm were 11.11 ＋1.59 mm and 6.30＋0.84 mm respectively, which were significant different from postoperative Da 11.63_＋1.47 mm and Dm 6.62＋0.80 ram. The postoperative Da and Dm at C3-4, Ca-s, C5-6, C6-7 levels had statistically significant differences compared to preoperative Da and Din, except for ones at C2-a level. The significant migration rate was 43.2%（35/81）, which reached ADa 〉2 mm or ADm 〉1.3 mm. Preoperative cervical curvature index （CCI） was 10.0%±6.3%, which was significant different from postoperative CCI 13.5%±6.5%. JOA score increased from 9.7±1.5 preoperatively to 13.7±.1 at one week postoperatively, and 13.9±1.3 at 6 months postoperatively. But the JOA score decreased at 6 months post- operatively compared with that at 1 week postoperatively in 15 cases. Among them, 14 cases got the standard of spinal cord mi- gration based on MRI measurement. No other severe complications were found in these 81 cases. Conclusion Anterior migra- tion of the spinal cord commonly occurred after cervical decompression and reconstruction via anterior approach, and some patients might suffer from t

关 键 词：颈椎病 脊柱融合术 减压术 外科 

分 类 号：R687.3[医药卫生—骨科学]