电生理监护下改良Cloward前路减压融合术治疗颈椎病的临床研究  

Treatment of cervical spodylosis by the anterior approach microdecompression with intraoperative electrophysiological monitoring.

作　　者：费智敏[1] 王勇[1] 周正文[1] 书国伟[1] 金萍茜[1] VernonLeoTowle 罗其中[1] 

机构地区：[1]上海第二医科大学附属仁济医院神经外科,上海200001 [2]美国芝加哥大学附属医院神经外科

出　　处：《中国神经精神疾病杂志》2002年第3期161-165,共5页Chinese Journal of Nervous and Mental Diseases

基　　金：上海市科委课题 (编号 :9941190 4 7)资助

摘　　要：目的　探讨改良Cloward前路减压融合术联合术中电生理监护治疗颈椎病的疗效。方法　借助显微镜和高速磨钻对 6 0例颈椎病患者进行颈前入路椎管内显微减压术 ,植骨后并使用钛板固定 ;术中同时采用体感诱发电位 (SEP)和运动诱发电位 (MEP)进行监护。结果　本组病例术中均未发生持续的SEP和MEP改变 ,术后无严重的并发症 ;随访 3～ 6 1个月 ,影像学检查证实 :脊髓和神经根的压迫得到了明显的改善 ,自身髂骨植入块融骨良好 ,内固定钛板位置准确 ;术后JOA评分 1 5分以上者 5 1例 ,1 3～ 1 4分者 9例 (经G检验 :P <0 0 1 ) ,无 1例患者症状复发或加重。结论　采用改良Cloward前路椎管内显微减压融合并钢板固定术联合术中神经电生理监护治疗难治性颈椎病 ,手术创伤小 。Objective To investigate efficacy of the anterior approach microdecompression and interbody fusion with intraoperative electrophysiological monitoring for the treatment of cervical spine disease. Methods Bone, disc and osteophyte removal were done by high speed drilling under operating microscope. After decompression, an autologous bone graft was used for interbody infusion, and the application of internal fixation was employed. During surgery, somatosensory evoked potentials (SEP) and motor evoked potentials (MEP) were used as intraoperative monitoring. Results There were no continuous changes of SEP and/or MEP waveform during the operation, and there were no serious complications. During postoperative follow up of 3～61 months, radiological studies indicated spinal cord and never root were decompressed sucessfully. Autologous bone grafts were well posed with a good location of Titanium plate fixator. There were 51 cases with the score of JOA higher than 15 and 9 with the score 13～14 (By G test, P<0.01, compare with preoperative). No patient complained of the symptom of deterioration and recurrence.Conclusions The treatment of disc and ligamentous disease of the cervical spine by the anterior approach microdecompression and internal fixation with intraoperative monitoring is a good method. The advantage included: 1) Small surgical scar that avoid cosmetic problem; 2) The operation under microscope is minimally invasive; 3) Intraoperative monitoring prevents neurological deficit and vascular injury; 4) The surgical procedure is safe and feasible.

关 键 词：颈前入路 椎管内显微减压术 颈椎病 改良cloward前路减压融合术 神经电生理监护 

分 类 号：R681.55[医药卫生—骨科学]