前路椎体次全切除结合椎间隙减压植骨融合术治疗多节段脊髓型颈椎病  

Treatment of multilevel cervical spondylotic myelopathy by conjugation of anterior vertebral subtotal resection and intervertebral space decompression and bone graft fusion

作　　者：刘斐文[1] 张彤[1] 孙川江[1] 谢涛江 王永亮[1] 张雪锋[1] 

机构地区：[1]攀钢集团总医院骨科,四川攀枝花617023

出　　处：《临床骨科杂志》2016年第4期411-414,共4页Journal of Clinical Orthopaedics

摘　　要：目的评价前路椎体次全切除结合椎间隙减压植骨融合术治疗多节段脊髓型颈椎病（CSM）的临床疗效。方法采用前路手术治疗累及3个节段的CSM患者46例。其中24例行椎体次全切除＋单间隙减压植骨融合术（A组）;22例行2个椎体次全切除减压植骨融合术（B组）。观察比较两组手术时间、术中出血量、植骨融合率、神经功能改善、颈椎生理曲度恢复情况。结果患者均获得随访,时间15-36个月。手术时间：A组（105±20）min,B组（180±30）min;术中出血量：A组（120±35）ml,B组（210±25）ml;两项指标两组比较差异均有统计学意义（P〈0.05）。术后3个月植骨融合率：A组为100%,B组为77.3%,差异有统计学意义（P〈0.05）。神经功能改善优良率：A组为83.3%,B组为81.8%,差异无统计学意义（P〉0.05）。两组术后颈椎生理曲度均得到明显改善,差异无统计学意义（P〉0.05）。结论前路椎体次全切除结合椎间隙减压植骨融合术治疗多节段CSM可取得满意的疗效,具有操作相对简单、出血少、手术时间短、植骨融合率高等优点,是减少并发症的安全有效的手术方法。Objectives To evaluate clinical effect of multilevel cervical spondylotic myelopathy（ CSM） treated by anterior vertebral subtotal resection conjugated with intervertebral space decompression and bone graft fusion. Methods Forty-six cases of CSM whose three segments were received anterior approach treatment. Among them,24 cases received vertebral subtotal resection conjugated with single cell gap decompression and bone graft fusion as Group A,and the other 22 cases were given subtotal resection decompression of two vertebral bodies and decompression and bone graft fusion as Group B. Operation time and bleeding,bone graft fusion rate,nerve function amelioration and cervical vertebra physiological curvature restoration were observed and compared. Results All patients were followed up for 15 - 36 months. Operation time in Group A was（ 105 ± 20） min,while that in Group B was（ 180 ± 30） min,bleeding during operation were（ 120 ± 35） ml in group A and（ 210 ± 25） ml in group B,the difference of the data between two groups were statistically significant（ P〈0. 05）. Bone graft fusion rates of three months after operation were 100% in Group A and 77. 3% in Group B,also with statistical significance（ P〈0. 05）. Nerve function amelioration rates were 83. 3% in Group A and 81. 8% Group B,showed no statistical significance（ P〈0. 05）. Postoperation cervical vertebra physiological curvature of both groups were obviously ameliorated,without statistical significance（ P〈0. 05）. Conclusions Multilevel CSM treatment by anterior vertebral subtotal resection conjugated with intervertebral space decompression and bone graft fusion can gain satisfactory effect,with advantages such as relatively simpler operations,less bleeding,shorter operation time,higher bone graft fusion rates,and so on. It is a safe,effective operation method which can also reduce complications.

关 键 词：脊髓型颈椎病 外科减压术 植骨融合 

分 类 号：R687.3[医药卫生—骨科学] R681.53[医药卫生—外科学]