保留C_4或C_5椎体的改良颈前路椎体次全切植骨融合内固定术治疗四节段脊髓型颈椎病效果研究  

Treatment of Four-level Cervical Spondylotic Myelopathy with Modified Anterior Cervical Corpectomy and Fusion without Removing C_4 or C_5 Vertebral Body

作　　者：冯浩[1] 陈焕诗[1] 白瑞飞[1] 易军飞[1] 

机构地区：[1]广西柳州市柳铁中心医院广西医科大学附属柳铁临床医学院,545007

出　　处：《中国全科医学》2018年第2期244-248,共5页Chinese General Practice

摘　　要：目的探讨保留C_4或C_5椎体的改良颈前路椎体次全切植骨融合内固定术治疗4节段脊髓型颈椎病(CSM)的短期临床疗效。方法选取2013—2014年于柳州市柳铁中心医院手术治疗的4节段CSM患者11例为研究对象,3例C_(2/3)、C_(3/4)、C_(4/5)、C_(5/6)椎间盘变性并突出患者,手术方式选择次全切除C_3、C_5椎体,保留C_4椎体;8例C_(3/4)、C_(4/5)、C_(5/6)、C_(6/7)椎间盘变性并突出患者,手术方式选择次全切除C_4、C_6椎体,保留C_5椎体,行分节段减压钛笼植骨融合钛板内固定术。记录手术时间、术中出血量、术后引流量。采用改良的日本骨科协会(JOA)评分标准评估术前、术后3个月、术后6个月及末次随访时神经功能,并计算改善率。分别于术前、术后3个月、末次随访时经影像学检查评估颈椎生理曲度恢复情况。结果11例患者手术时间(165±35)min,术中出血量(735±159)ml,术后引流量(120±39)ml。术后3、6个月及末次随访JOA评分分别为(15.4±2.1)、(15.5±2.1)、(16.1±1.9)分,均高于术前的JOA评分(12.6±2.9)分(P<0.05);平均改善率分别为(59.9±10.3)%、(62.7±8.4)%、(63.1±7.7)%。术后3个月及末次随访时颈椎生理曲度分别为(12.8±4.2)、(13.0±3.2)mm,均大于术前的(9.2±3.1)mm(P<0.05)。末次随访未发现钛笼下沉、钢板螺钉松动移位等并发症,均获得骨性融合。结论保留C_4或C_5椎体的改良颈前路椎体次全切植骨融合内固定术治疗4节段CSM可获得满意的短期疗效,保留C_4或C_5椎体可增加固定钢板螺钉的把持力,分节段减压植骨融合有利于恢复颈椎生理曲度,同时可增加植骨面,从而提高植骨融合率。Objective To investigate the short-term clinical efficacy of the treatment in four-level cervical spondylotic myelopathy（CSM）with modified anterior cervical corpectomy and fusion（ACCF）without removing C_4 or C_5 vertebral body.Methods We enrolled 11 patients with CSM in 4 segments who received modified ACCF（segmental decompression,fusion with bone grafting with titanium cage,and internal fixation with titanium plate）in Liuzhou Municipal Liutie Central Hospital from 2013 to 2014.During the surgery,3 suffering from spinal stenosis in C_（2/3）,C_（3/4）,C_（4/5） and C_（5/6） segments were treated with subtotal resection of C_3 and C_5 vertebral bodies without removing C_4 vertebral body,the other 8 suffering from spinal stenosis in C_（3/4）,C_（4/5）,C_（5/6）and C_（6/7） segments were treated with subtotal resection of C_4 and C_6 vertebral bodies without removing C_5 vertebral body.The duration of surgery,intraoperative blood loss and postoperative drainage volume were recorded.Neurological function was evaluated before surgery,at 3,6 months after surgery and final follow-up time by the modified JOA score,and improvement rate were calculated.The physiological curve of cervical spine was assessed by imaging examination performed before surgery,at 3 months after surgery and the final follow-up.Results The mean duration of surgery,intraoperative blood loss and postoperative drainage volume for the 11 patients was（165±35）min,（735±159）ml,（120±39）ml,respectively.The JOA score was（12.6±2.9）before the surgery,but was improved to（15.4±2.1）at 3 months after surgery,（15.5±2.1）at 6 months after surgery and（16.1±1.9）at the final follow-up（P〈0.05）,with a mean improvement rate of（59.9±10.3）%,（62.7±8.4）%,and（63.1±7.7）%,respectively.The average cervical physiological curve increased from（9.2±3.1）mm before the surgery to（12.8±4.2）mm at 3 months after surgery and（13.0±3.2）mm at the final follow-up（P〈0.05）.All cases got bony

关 键 词：颈椎病 多节段脊髓型颈椎病 分节段减压 植骨融合术 

分 类 号：R681.5[医药卫生—骨科学]