颈椎前路多节段椎体次全切减压植骨融合内固定术治疗多节段脊髓型颈椎病  

Anterior Decompression by Subtotal Vertebrectomy Combined with Bone Grafting and Internal Fixation in Treatment of Multilevel Cervical Spondylotic Myelopathy

作　　者：刘长安[1] 张卫平[1] 王凌云[1] 王宇清[1] 步建立[1] 冯志军[1] 

机构地区：[1]解放军白求恩国际和平医院骨科,石家庄050082

出　　处：《解放军医药杂志》2015年第4期24-27,36,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

摘　　要：目的探讨颈椎前路多节段椎体次全切减压植骨融合内固定术治疗多节段脊髓型颈椎病的方法和临床疗效。方法回顾性分析2008年3月—2012年6月采用颈前路多节段椎体次全切减压植骨融合内固定术治疗多节段颈椎病38例,均为3个及以上责任节段病变。观察术后手术并发症情况,根据术前、后颈椎侧位X线片上测量颈椎曲度C值,观察手术间隙融合情况,根据JOA评分系统进行术后疗效评价。结果术后1例发生脑脊液漏,2例出现一过性喉返神经损伤。术后12个月患者神经症状均好转,37例可见椎间隙骨性融合,术后6、12个月的颈椎曲度C值和JOA评分均较术前有明显改善(P<0.05)。结论颈前路多节段椎体次全切减压植骨融合内固定术可达到充分减压,即刻重建颈椎生理曲度及稳定性,是治疗多节段颈椎病的有效方法。Objective To investigate the surgical methods and clinical effects of anterior decompression by subtotal vertebrectomy combined with bone grafting and internal fixation in treatment of multilevel cervical spondylotic myelopathy. Methods Clinical data of 38 patients with multilevel cervical spondylosis undergoing anterior decompression by subtotal vertebrectomy combined with bone grafting and internal fixation during March 2008 and June 2012 was retrospectively analyzed,and three levels or more levels of segment lesions were involved in all the patients. The postoperative complications were observed,and C values of cervical curvature were measured based on preoperative and postoperative results of lateral cervical X-rays. The sagittal segmental fusion was observed,and postoperative curative effect was evaluated based on JOA（ Japanese Orthopedic Association） score. Results There were 1 patient with cerebrospinal fluid leakage and 2 patients with temporary recurrent laryngeal nerve injury after the operation. Neurological symptoms were improved in 12 month postoperatively,and intervertebral bony fusion was found in 37 patients. The C values of cervical curvature and the JOA scores were significantly improved in 6^th and 12^th month postoperatively（ P〈0. 05）. Conclusion Anterior decompression by subtotal vertebrectomy combined with bone grafting and internal fixation is an effective technique in treatment of multilevel cervical spondylotic myelopathy,which can make full decompression,rebuilt the physiological cervical curvature and achieve immediate stability.

关 键 词：颈椎病 减压术 外科 骨移植 脊柱融合术 

分 类 号：R681.5[医药卫生—骨科学]