显微镜辅助经前路颈椎间盘切除融合术治疗颈椎病37例  

The efficacy of microscope-assisted anterior cervical discectomy and fusion with cervical spondylosis for 37 cases

作　　者：王晶[1] 杜江[1] 梁耀中[1] 卢陈欢 朱铠睿 江宓翁 余慧欢 Wang Jing;Du Jiang;Liang Yaozhong;Lu Chenhuan;Zhu Kairui;Jiang Miweng;Yu Huihuan(Department of Orthopedics,The First Affiliated Hospital of Jinan University,Guangzhou 510632,China)

机构地区：[1]暨南大学附属第一医院骨科,广州510632

出　　处：《中华显微外科杂志》2019年第3期241-245,共5页Chinese Journal of Microsurgery

基　　金：暨南大学附属第一医院临床医学研究项目(806014).

摘　　要：目的探讨经前路显微镜辅助下减压植骨融合术的有效性与安全性.方法回顾性分析2015年10月至2018年2月采用显微镜辅助下前路颈椎间盘切除融合术(ACDF)治疗37例颈椎病患者资料,其中男21例,女16例,年龄22~77岁,平均(51.5±6.2)岁.单节段手术30例,2节段手术6例,3节段手术1例.所有病例中脊髓型颈椎病15例,占40.54%;神经根型颈椎病22例,占59.46%.手术均采用颈前横切口,安置椎间撑开器,在显微镜辅助下完成减压,在直视下行融合固定.记录患者术中出血量、手术时间及手术相关并发症;于术后7d、1个月、3个月、6个月及术后1年进行随访,采用日本骨科协会(JOA)评分并计算神经功能改善率以评估临床疗效;采用颈椎功能障碍指数(NDI)评定颈椎功能.结果本组均在显微镜下顺利完成减压,手术时间90~160min,平均(110.67±36.42)min;术中出血量20~110ml,平均(36.00±29.11)ml.本组术后随访12~31个月,平均(15.2±4.7)个月.JOA评分由术前的(8.37±3.26)分改善至末次随访时的(15.96±1.50)分,差异有统计学意义(P<0.05);神经功能改善率分级,优31例,良6例,优良率100%;NDI自术前19.01±6.47降至末次随访时的5.81±2.58,差异有统计学意义(P<0.05).随访期间1例女性患者术后3个月随访发现1枚螺钉松动并少许退出,无明显不适,继续观察未见螺钉继续退出;无脑脊液漏、声音嘶哑及吞咽困难等并发症.结论显微镜辅助下行前路颈椎间盘切除融合术能在不明显延长手术时间的情况下进行安全充分的减压,临床疗效满意;在单节段或2节段椎间盘髓核脱出的病例中,可以避免行创伤较大的前路颈椎次全切除融合术(ACDF),值得临床推广.Objective To explore the efficacy and safety of anterior cervical discectomy and fusion assisted with microscope.Methods Thirty-seven patients with cervical spondylosis were included to be retrospectively ana lyzed,including 21 males and 16 females.All these patients had accepted anterior cervical discectomy and fusion (ACDF) assisted with microscope from October,2015 to February,2018,and they were aged from 22 to 77 years old (51.5±6.2 years on the average).In these patients,30 cases were operated on single segment,6 cases were operated on double segments,and 1 case was operated on 3 segments.Among all the patients,15 patients of which (40.54%) had cervical spondylotic myelopathy and 22 patients of which (59.46%) sufferered from cervical spondylotic radicu lopathy.All the operations were performed with a conventional transverse anterior cervical incisions,an intervertebral distractor was placed.The decompression was completed under the microscope,and the fixation was performed under direct vision.Moreover,the operative time,intraoperative blood loss and surgery-related complications were recorded.Follow-up was carried out at different times,including 7 days,1 month,3 months,6 months and every year after operation.Japanese Orthopaedic Association (JOA) score was used to calculate the rate of improvement in neurological function,which can evaluate the clinical efficacy.And cervical dysfunction index (NDI) was used to assess cervical function.Results All patients in this group underwent successful decompression under the microscope.The operation time was 90-160 min,with an average of (110.67±36.42) min;The intraoperative blood loss was 20-110 ml,with an average of (36.00±29.11) ml.All patients were followed-up for 12-31 months,with an average of (15.2±4.7) months.The JOA score improved from 8.37±3.26 preoperatively to 15.96 ± 1.50 at the last follow-up,and its difference had signifi cance in statistics (t=8.592,P=0.000).Neurological function improvement rate could be graded:excellent in 31 cases and good in 6

关 键 词：颈椎病 经前路 颈椎间盘切除融合术 显微外科技术 

分 类 号：R687.3[医药卫生—骨科学]