脊髓腹侧受压颈椎病合并重度骨质疏松的手术治疗方法  

Surgery treatment of ventral spinal cord compression cervical spondylosis myelopathy with severe osteoporosis

作　　者：杜文君[1] 李辉南[1] 耿梦龙 夏英鹏[1] 申庆丰[1] 于斌[1] 

机构地区：[1]天津市人民医院脊柱中心,天津300121

出　　处：《中国骨与关节损伤杂志》2018年第1期5-8,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨脊髓腹侧受压颈椎病合并重度骨质疏松症的手术治疗方法及效果。方法回顾性分析自2012-05—2016-06采用一期颈椎后路扩大开门角度单开门椎管成形术治疗的32例脊髓腹侧受压颈椎病合并重度骨质疏松症。术后以JOA评分标准评估患者颈肩痛及四肢神经功能的恢复情况。结果本组各节段平均椎板开门角度为(59.6±15.5)°,均>30°。32例获得12~36(20.7±7.4)个月随访,术后复查MRI显示所有患者脊髓充分后移,脊髓腹侧减压满意。术后2例出现轴性症状,术后3个月症状消失;1例术后3 d出现单侧C5神经根麻痹,术后40 d功能完全恢复。术前JOA评分为(7.0±1.6)分,术后10 d为(11.4±1.4)分,术后6个月为(15.3±1.5)分;术后10 d的JOA评分较术前明显提高,且术后6个月JOA评分较术后10 d明显提高,差异有统计学意义(P<0.05)。术后6个月神经功能改善率为(83.8±14.8)%,神经功能改善评价为优。结论颈椎后路扩大开门角度单开门椎管成形术治疗合并骨质疏松的脊髓腹侧受压颈椎病手术操作安全,疗效可靠,且术后并发症未明显增多。Objective To investigate the surgical treatment and curative effect of the ventral spinal cord compression cervical spondylosis myelopathy with severe osteoporosis. Methods Thirty-two cases of cervical spondylosis combined with severe osteoporosis were collected in our hospital from May 2012 to June 2016. These patients underwent cervical posterior expansion of unilateral open-door laminoplasty. The JOA score was used to evaluate the patients with neck and shoulder pain and limbs nerve function recovery. Results In this group, each segment average lamina angle to open-door was （59.6±15.5）°, every angle over 30°. Thirty-two cases received 12-36 （20.7±7.4） months follow-up, postoperative MRI showed that all patients had spinal cord fully backwards, the spinal cord ventral decompression was satisfactory. Postoperative axial symptoms occurred in 2 cases, but disappeared after 3 months. Unilateral C5 nerve root palsy occurred in 1 case and was completely recovered 40 days after surgery. JOA score was （7.0±1.6） points before operation, （11.4±1.4） points 10 days after surgery and was （15.3±1.5） points 6 months after surgery. The JOA score 10 days after operation was significandy higher than that before operation, and the score 6 months after operation was significantly higher than the score 10 days after operation, these differences were statistically significant （P 〈0.05）. Improvement rate of neurological function 6 months after operation was （83.8±14.8）%, evaluation of neurological function was excellent. Conclusion The cervical posterior expansion of unilateral open-door laminoplasty for the treatment of ventral spinal cord compression cervical spondylosis myelopathy with severe osteoporosis is safe and effective, and the postoperative complications are not significantly increased.

关 键 词：脊髓型颈椎病 脊髓腹侧受压 骨质疏松症 单开门椎管成形术 扩大开门角度 

分 类 号：R681.5[医药卫生—骨科学]