椎间隙扩大减压治疗全椎板减压术后颈髓再次受压的疗效  

Clinical effective of enlarged anterior cervical diskectomy and fusion in the treatment of recurrent anterior compression after laminectomy

作　　者：刘法敬[1] 丁晓坤[2] 胡成栋[1] 李彦飞[1] 胡洋[1] 田金辉 周玉军[1] 张恩录[1] Liu Fajing;Ding Xiaokun;Hu Chengdong(The Second Department of Orthopedies,Handan Central Hospital;The Gastroenterology Department,Handan Chinese Medicine Hospital,Handan Hebei,056001,China)

机构地区：[1]邯郸市中心医院骨2科 [2]邯郸市中医院脾胃科,河北邯郸056001

出　　处：《生物骨科材料与临床研究》2018年第5期35-37,共3页Orthopaedic Biomechanics Materials and Clinical Study

基　　金：河北省医学科学研究重点课题(项目编号:20150452)

摘　　要：目的观察椎间隙扩大减压椎间融合内固定术在治疗全椎板减压术后颈髓再次前方受压的临床疗效。方法2013年10月~2016年05月有27例全椎板减压术后前方致压物再次压迫颈髓的患者在我院接受手术治疗,均采用颈前路椎间隙扩大减压椎间融合内固定术治疗,其中男15例,女12例,年龄55~76岁,平均65.1岁。术后观察患者神经功能恢复、颈椎曲度改变及并发症发生情况。结果平均手术时间(79.6±13.3)min,术中出血量(73.8±16.1)mL。术后JOA评分由术前的(7.6±2.1)分恢复为术后3个月时的(12.1±3.2)分及末次随访时的12.7±3.4分,不同时间点比较具有统计学意义(P<0.05),末次随访时神经功能改善率为(47.9±11.3)%。术前颈椎曲度指数为(12.2±3.7)%,术后3天为(14.4±3.9)%及末次随访时减小为(14.3±4.0)%,手术前后比较有显著统计学差异(P<0.05)。术中有2例患者发生脑脊液漏,行腰大池置管引流及加压包扎后切口均I期愈合。结论颈前路椎间隙扩大减压椎间融合内固定术是一种有效的翻修术式,可充分除脊髓前方压迫并促进神经功能恢复,同时能够较好的维持颈椎稳定性。Objective To observe the clinical effective of enlarged anterior cervical diskectomy and fusion（E-ACDF） in the treatment of recurrent anterior compression after laminectomy. Methods From Oct 2013 ~ May 2016, 27 cases of patients with recurrent anterior compression after laminectomy accepted the procedure of E-ACDF. There were 15 males and 12 females, aged 55 ~ 76 years, averaged 65.1 years. The postoperative neurological recovery, cervical curvature index（CCI） and complications were recorded and analyzed. Results No spinal cord and nerves injury occurred during the operation. The mean operative time was（79.6 ±13.3） min with a blood loss of（73.8 ±16.1） mL. The Japanese Orthopedic Association（JOA） scale was improved form 7.6±2.1 preoperatively to 12.1±3.2 three months after surgery,and 12.7±3.4 at the final follow up（P〈0.05）, with a neurological recovery rate of（47.9±11.3） %. The CCI was corrected from（12.2±3.7） % preoperatively to（14.4±3.9） % three days after surgery, and（14.3±4.0） % at the last follow-up（P〈0.05）. There were 2 cases of cerebrospinal fluid leakage occurred during operation, and the incision was healed by lumbar cerebrospinal fluid drainage and bandaging pressure. Conclusion As an effective revision surgery, EACDF could remove the recurrent anterior compression effectively. Moreover, it significantly promote the neurological function and maintain the stability of the cervical spine.

关 键 词：颈椎 椎间植骨融合 全椎板减压术 翻修 内固定 

分 类 号：R681.5[医药卫生—骨科学]