颈椎前路融合术后相邻节段退变的手术治疗  

Surgical treatment for adjacent spinal segment degeneration after anterior cervical fusion

作　　者：占蓓蕾[1] 叶舟[1] 

机构地区：[1]衢州中心医院骨科,浙江衢州324000

出　　处：《中国骨伤》2014年第2期140-144,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的：探讨颈椎前路减压融合术后相邻节段退变的手术治疗方法与效果。方法：自2000年3月至2011年3月，采用手术治疗颈椎前路减压融合术后相邻节段退变患者27例，男16例，女11例；年龄48—72岁，平均55．3岁。术后通过JOA评分、影像学检查，评价手术疗效。结果：所有病例获得随访，时间1．8～712年，平均3．6年。病变节段减压充分、脊髓膨隆良好，内固定无松动，无颈椎节段不稳发生。术后神经根性痛消失，神经功能明显改善。术前、术后3d、末次随访JOA评分分别为9．15±3．46，13．96±2．79，13．52±2．91，手术前后比较差异有统计学意义（P〈0．05）。椎间高度和生理曲度与术前比较均有明显改善（P〈0．05）。结论：对于有脊髓神经症状体征的相邻节段退变应尽早手术治疗，以解除脊髓压迫，重建脊柱稳定，根据受压部位不同，采用合理的手术方法大多能获得满意的效果。Objective ：To explore the surgical method and its effects of adjacent spinal segment degeneration after anterior cervical fusion. Methods：From March 2000 to March 2011,27 patients with spinal segment degeneration who had accepted the operation of anterior cervical fusion were treated with surgical treatment. There were 16 males and 11 females with an aver- age age of 55.3 years （ranged from 48 to 72 years）. JOA scores and image examination were used to evaluate the clinical ef- fects. Results：All patients were followed up for 1.8 to 7.2 years with an average of 3.6 years. All pathological segments ob- tained fully decompression with good spinal bombe, no internal fixation loosening and cervical spine instability were found. Nerve root pain had disappeared and nerve function had significantly improved. Before operation, 3 days after operation and at last follow-up,JOA scores were 9.15±3.46,13.96±2.79 and 13.52±2.91 ,respectively, and there was significant difference be- tween preoperation and postoperation （P〈0.05）. Intervertebral height and physiological curvature improved obviously than pre- operation （P〈0.05）. Conclusion：In order to relief spinal compression and rebuild spinal stability, a surgical treatment will be recommend to adjacent spinal segment degeneration combining spinal nerve symptoms and physical sign as soon as possible. Selecting an appropriate surgery to treat different compressed segment would receive satisfactory results.

关 键 词：颈椎 脊柱融合术 手术后并发症 相邻节段退变 再手术 

分 类 号：R687.1[医药卫生—骨科学]