颈后路椎板减压联合椎间孔切开术治疗混合型颈椎病的疗效观察  

CLINICAL OBSERVATION OF POSTERIOR CERVICAL DEC OMPRESSIVE LAMINECTOMY AND LATERAL MASS SCREW FIXATION COMBINED WITH FORAMINOTOMY FOR CERVICAL RADICULO-MYELOPATHY

作　　者：方钊[1] 田融[1] 孙天威[1] 贾宇涛[1] 徐天同[1] 申庆丰[1] 夏刚[1] 刘洋[1] 李会明[1] 

机构地区：[1]天津市人民医院脊柱外科,天津300121

出　　处：《中国修复重建外科杂志》2016年第8期980-984,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨颈后路椎板切除减压侧块螺钉内固定联合椎间孔切开术治疗脊髓合并神经根受压的混合型颈椎病疗效。方法 2010年1月-2012年1月,采用颈后路椎板切除减压侧块螺钉内固定联合椎间孔切开术治疗58例混合型颈椎病患者。男31例,女27例;年龄41~72岁,平均52.7岁。病程3~15年,平均5.4年。术前日本骨科协会（JOA）评分为（7.8±1.3）分,疼痛视觉模拟评分（VAS）为（6.8±1.7）分。椎间盘突出伴黄韧带肥厚37例,椎体后缘骨赘形成11例（骨赘椎管占有率为51.7%±18.1%）,颈椎不稳合并椎间盘突出10例。颈椎曲度为（—5.5±12.5）°。螺钉固定节段：C3~7 29例,C4~7 19例,C3~6 10例;共切开椎间孔135个,平均每例2.33个。结果手术时间167~260 min,平均204 min;术中出血量为210~378 m L,平均273 m L。术中无椎动脉、神经根损伤发生。术后1例发生皮下血肿,8例轴性疼痛;均无颈神经根麻痹症状发生。患者均获随访,随访时间2.1~4.3年,平均3.4年。术后2年,JOA评分为（14.1±1.7）分,显著高于术前,比较差异有统计学意义（t=—27.672,P=0.000）;JOA评分改善率为68.5%±21.9%。VAS评分为（2.1±1.1）分,较术前显著降低,比较差异有统计学意义（t=15.168,P=0.000）。影像学复查示,1例邻近节段发生退变,但未出现临床症状;随访期间无螺钉松动、无假关节形成。术后5 d及2年颈椎曲度分别为（13.6±5.1）、（13.2±4.8）°,与术前比较差异均有统计学意义（P〈0.05）。术后2年11例骨赘椎管占有率为36.5%±10.4%,与术前比较差异有统计学意义（t=6.921,P=0.000）;随访期间骨赘残余压迫逐渐吸收。结论对脊髓合并神经根受压的混合型颈椎病,采用颈后路椎板切除减压侧块螺钉内固定联合椎间孔切开术治疗可获得满意疗效。术中扩大椎板切除（椎板切除和椎间孔切开）能充分缓解脊髓及神经根受压症状,侧块螺钉内固定在纠正颈椎曲度的�Objective To evaluate the effectiveness of posterior cervical decompressive laminectomy and lateral mass screw fixation combined with foraminotomy for treating cervical radiculo-myelopathy. Methods Between January 2010 and January 2012, 58 patients with cervical radiculo-myelopathy were treated by posterior cervical decompressive laminectomy and lateral mass screw fixation combined with foraminotomy. There were 31 males and 27 females, with an average age of 52. 7 years（range, 41- 72 years）. The mean disease course was 5. 4 years（range, 3- 15 years）. The preoperative Japanese Orthopaedic Association（JOA） score was 7. 8 ± 1. 3, and visual analogue scale（VAS） score was 6. 8 ± 1. 7. There were 37 cases of inter-vertebral disc herniation and ligamentum flavum hypertrophy, 11 cases of vertebral osteophyte formation with the osteophyte spinal canal occupational ratio of 51. 7 %± 18. 1 %, and 10 cases of inter-vertebral disc herination with cervical instability. Preoperative cervical curvature was（— 5. 5 ± 12. 5）°. The fixed segments included C 3- 7 in 29 cases, C 4- 7 in 19 cases, and C 3- 6 in 10 cases. Foraminotomy was performed in 135 nerve foramina（mean, 2. 33 foramina）. Results The mean operation time was 204 minutes（range, 167- 260 minutes）, and the mean blood loss was 273 m L（range, 210- 378 m L）. No injury of vertebral artery or nerve root occurred during operation. Postoperative subcutaneous hematoma and cervical axial pain occurred in 1 case and 8 cases, respectively; and no nerve root palsy was observed. The patients were followed up 2. 1- 4. 3 years（mean, 3. 4 years）. The postoperative JOA score was significantly increased to 14. 1 ± 1. 7（t= — 27. 672, P= 0. 000）, with an improvement rate of 68. 5 %± 21. 9 %. Postoperative VAS score was significantly decreased to 2. 1 ± 1. 1（t= 15. 168, P= 0. 000）. The imaging examination showed adjacent segmental degeneration in 1 patient, who had no clinical symptom. There was no screw loosening or pseudoarthrosis fo

关 键 词：颈椎退变 混合型颈椎病 颈后路减压术 颈椎曲度 

分 类 号：R687.3[医药卫生—骨科学]