颈椎后路单开门椎管成形术治疗多节段脊髓型颈椎病38例分析  

Treatment of multi-segmental cervical spondylotic myelopathy with posterior cervical single-door laminoplasty:a report of 38 cases

作　　者：陶海鹰[1] 贺斌[1] 卫爱林[1] 陶凤华[1] 李孝海[1] 杨俭[1] 袁敏[1] 沈其孝 

机构地区：[1]武汉大学人民医院脊柱外科,430060 [2]湖北省阳新县人民医院骨二科

出　　处：《临床外科杂志》2017年第1期62-64,共3页Journal of Clinical Surgery

摘　　要：目的评价颈椎后路单开门椎管成形术结合微型钛板治疗多节段脊髓型颈椎病(cervical spondylotic myelopathy,CSM)的临床疗效,分析手术并发症的原因。方法采用颈椎后路单开门椎管扩大成形结合微型钛板治疗多节段CSM 38例,均采用颈椎后路C_3~C_7单开门椎管扩大成形术,记录手术时间、术中出血量、术后引流量,比较术前、术后日本骨科学会评分(JOA)评分、颈椎曲度、视觉模拟评分(VAS)评分,随访术后神经功能改善情况,颈椎活动度并分析术后并发症。结果 JOA评分[术前(7.1±0.9)比术后(3.6±1.2)]及VAS评分[术前(5.2±2.8)比术后(2.3±1.1)]较术前改善明显,所有患者术后神经功能与术前比较均明显改善,差异有统计学意义(P<0.05);颈椎活动度无明显变化[术前(36.9±6.3)度比术后(32.7±2.4)度,P>0.05];术后发生脑脊液漏1例,术后第5天改善,发生C,神经根麻痹1例,于术后2个月改善,未发生脊髓损伤、钛板断裂、伤口感染等并发症。结论颈椎后路单开门椎管扩大成形术结合微型钛板是治疗CSM的一种可靠的方法,可以持续维持扩大椎管的管径,取得较好的远期临床疗效,并且有利于维持颈椎生理曲度。Objective To investigate the clinical effects of cervical single-door with micro titani-um plate on multiple segmental cervical spondylotic myelopathy（CSM）.Methods The clinical results of 38 cases of CSMpatients in treatment of single-door with micro titanium plate were studied.The operation time,blood loss,postoperative drainage,cervical curvature,surgical complications,neurological function, the change of range of motion and scores of JOA and VAS were compared.Results The neurological function recovery,scores of JOA and VAS compared with preoperative were obvious,the difference was sta-tistically significant（P 〈0.05）.There was no significant difference in range of motion[（36.9 ±6.3）°vs （32.7 ±2.4）°,P 〉0.05].There was one case of postoperative cerebrospinal fluid leakage,on the first postoperative 5 days the symptom was improved;there was one case of C5 nerve root palsy,after two months the symptom was improved.Conclusion Cervical single door laminoplasty will be a effective op-eration for treatment of patients with CMS.

关 键 词：脊髓型颈椎病 椎管扩大成形术 微型钛板固定 

分 类 号：R687.3[医药卫生—骨科学]