脊髓型颈椎病前路分段减压手术探讨  

Segmental anterior cervical decompression for treatment of multiple level cervical myelopathy

作　　者：苏小桃[1] 何俊[1] 

机构地区：[1]南华大学附属南华医院,湖南衡阳421002

出　　处：《中国现代医学杂志》2014年第25期69-71,共3页China Journal of Modern Medicine

摘　　要：目的 探讨颈前路分段减压植骨融合术治疗多节段脊髓型颈椎病的疗效。方法 该科采用前路分段减压植骨融合术治疗并获得随访的35例多节段脊髓型颈椎病患者。病情较轻者行椎间盘切除减压和自体髂骨植骨术,在病变严重的部位行椎体次全切除＋钛网或髂骨块植骨术。记录手术时间、出血量。根据JOA评估系统评估其疗效,记录患者术前、术后3及12个月时的JOA分值并计算改善率;采用X线正侧位、动力位和CT-3D重建方法来进行评估融合程度。结果 35例患者经10-52个月,平均25.6个月随访,所有患者在术后l个月内均感到神经症状有明显好转,下肢肌力增加,肢体活动度较术前明显改善,且双上肢感觉异常基本消失。JOA评分由术前的平均（8.35±2.34）分上升到术后（13.2±2.54）分,差异有显著性（P〈0.05）。术后改善率为56.1%,术后疗效按JOA标准评定[1]：优12例,良17例,可6例。术后12个月植骨融合率为100%,1例术后出现邻近节段退变现象,余无明显异常。结论 前路分段减压植骨融合术可达到充分的减压,即刻重建颈椎的稳定性,植骨融合率高,是治疗多节段脊髓型颈椎病的有效方法之一。【Objective】To evaluate the clinical effects of anterior segmental decompression and autograft fusion in treating multi-level cervical spondylotic myelopathy（CSM）. 【Methods】Data of multiple level CSM undergoing the segmental anterior cervical decompression were retrospectively analyzed. Mild cases underwent discectomy decompression and autogenous iliac bone grafting, in the severe lesion site for corpectomy and titanium mesh or iliac bone grafting. The incidence of perioperative complications and the rate of fusion were evaluated by the postoperative Xray and MRI examinations. The improvement of the neurological function was evaluated by the JOA score. X-ray,power and CT-3D reconstruction method was used for assessing the degree of integration. 【Results】All cases were followed up 10 to 52 months（25.6 months on average）, the nervous symptoms in all cases were improved significantly within 1 month after operation. Lower limb muscle strength increased, upper limb abnormal sensation disappeared,and limb moved more agile. The JOA score increased from（8.35±2.34） preoperatively to（13.2±2.54） at 12 months postoperatively with an improvement rate of 56.1%, showing significant difference（P 0.01）. According to JOA evaluation scale, the results were excellent in 12 cases, good in 17 cases, and fair in 6 cases, 12 months after operation,bone graft fusion rate was 100%. In 1 patient had the phenomenon of adjacent segment degeneration after operation,but others had no obvious abnormality. 【Conclusion】Anterior segmental decompression and autograft fusion is a recommendable technique for multi-level CSM, which can make full decompression, conserve the stability of cervical cord, and has high fusion rate.

关 键 词：脊髓型颈椎病 前路手术 分节段减压 

分 类 号：R681.53[医药卫生—骨科学]