颈前路椎体次全切除联合椎间隙减压融合治疗多节段脊髓型颈椎病  

Anterior corpectomy combined with intervertebral decompression and fusion for multilevel cervical spondylotic myelopathy

作　　者：黄凯 常步青 于潮将 高啸 蒋允昌 冯虎 

机构地区：[1]徐州医科大学研究生院,江苏徐州221000 [2]徐州医科大学附属医院脊柱外科,江苏徐州221000

出　　处：《中国骨伤》2018年第1期18-22,共5页China Journal of Orthopaedics and Traumatology

基　　金：江苏省"六大人才高峰"高层次人才基金资助项目(编号:2012-WSN-081)~~

摘　　要：目的:探讨多节段颈椎病颈前路椎体次全切除联合椎间隙减压融合内固定术的疗效。方法 :对2012年10月至2014年6月行颈椎前路治疗的28例脊髓型颈椎病的临床资料进行回顾性分析,其中男18例,女10例;年龄45~77(60.11±9.37)岁;27例患者病变累及3个节段,1例累及4个节段;术前JOA评分为8.89±1.87,拟融合节段Cobb角为(4.87±4.56)°,颈椎曲度为(11.68±1.25)°,均行颈椎前路椎体次全切除联合椎间隙减压融合内固定术。通过影像学资料测量术后1、12个月时的融合节段Cobb角、颈椎曲度,并采用JOA评分评价疗效。结果:手术时间120~205 min,平均163 min;术中出血量100~300 ml,平均198 ml;术后1例患者出现声音嘶哑,术后3周恢复正常;1例出现饮水呛咳,术后1周恢复正常。28例患者均获得随访,时间12~24(18.46±3.20)个月。术后12个月植骨椎间隙均获骨性愈合,内固定物位置良好。术后1、12个月时融合节段Cobb角与颈椎曲度及JOA评分均较术前明显改善(P<0.05)。术后12个月JOA评分改善率为(46.46±20.26)%,手术疗效根据改善率评定:优12例,良14例,好转2例。结论:颈椎前路椎体次全切除联合椎间隙减压融合内固定术治疗多节段颈椎病效果满意。Objective：To investigate the clinical outcomes of anterior corpectomy combined with anterior intervertebral decompression and fusion for multilevel cervical spondylotic myelopathy. Methods：The clinical data of 28 patients with multilevel cervical spondylotic myelopathy who underwent surgery from October 2012 to June 2014 were retrospectively analyzed. There were 18 males and 10 females,aged from 45 to 77 years old with an average of（60.11 ±9.37） years. Three levels were involved in 27 cases,while four levels were involved in 1 case. The preoperative JOA score was 8.89 ±1.87;the fusion segments angles was（4.87±4.56）°;and the cervical curvature was（11.68±1.25）°. Anterior hybrid decompression and fusion were performed in 28 patients. The fusion segments angles and the cervical curvature were assessed by X-rays at 1,12 months after operation,respectively. JOA score was used to evaluate the clinical effect. Results：The operative time was 163 min on average（ranged from 120 to 205 min）, and intraoperative bleeding was 198 ml on average（ranged from 100 to 300 ml）. Hoarseness occurred in 1 case and got recovery at 3 weeks after operation and choke cough occurred in 1 case,and got improvement at 1 week after operation. All the patients were regularly followed for 12-24 months with an average of（18.46±3.20） months. Graft bone obtained fusion at 12 months after operation and the position of internal fixation was good. The fusion segments angles,the cervical curvature and JOA scores were significantly improved at 1,12 months after operation（P〈0.05）.The improvement rate of JOA score was（46.46±20.26）% at 12 months after operation,12 cases got excellent results,14 good and 2 fair. Conclusion：Anterior corpectomy combined with anterior intervertebral decompression and fusion is safe and effective and can get satisfactory effects for multilevel cervical spondylotic myelopathy.

关 键 词：多节段颈椎病 减压术 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]