前后路联合手术治疗无骨折脱位颈脊髓损伤合并脊髓型颈椎病  

Combined anterior and posterior surgical procedures for cervical spinal cord injury without fracture and dislocation accompanied with cervical spondylitic myelopathy

作　　者：王正雷 郭宁[1] 高吉昌 张文进[1] 刘建辉[1] 王海斌 范庆建 宫明 荀琳 WANG Zheng-lei;GUO Ning;GAO Ji-chang;ZHANG Wen-jin;LIU Jian-hui;WANG Hai-bin;FAN Qing-jian;GONG Ming(Department of Orthopaedics,No.962 Hospital of PLA,Harbin 150080,China)

机构地区：[1]中国人民解放军第962医院骨二科,哈尔滨150080

出　　处：《中国矫形外科杂志》2020年第5期457-460,共4页Orthopedic Journal of China

摘　　要：[目的]采用前后路联合手术治疗无骨折脱位颈脊髓损伤合并脊髓型颈椎病。[方法]对8例无骨折脱位颈脊髓损伤合并脊髓型颈椎病患者行手术治疗。首先俯卧位行颈椎后路单开门椎管扩大成形,椎板钢板螺钉内固定,再改仰卧位行颈椎前路椎体次全切减压,取髂骨植骨钢板螺钉内固定。[结果]所有患者均顺利手术,无严重并发症。术后随访12~24个月,6例患者四肢麻木症状完全消失,2例大部分消失(P<0.05);8例四肢肌力较术前明显改善。[结论]前后路联合手术治疗脊髓型颈椎病合并无骨折脱位颈脊髓损伤,解除了来自前后方对脊髓的压迫,彻底减压,脊髓血供可得到提高和改善,有利于脊髓神经功能恢复,而且患者治疗周期短,疗效可靠,复发率低。[Objective]To introduce the surgical technique and primary clinical outcome of combined anterior and posterior surgical procedures for cervical spinal cord injury without fracture and dislocation accompanied with cervical spondylitic myelopathy.[Methods]A total of 27 patients underwent surgical treatment for cervical spinal cord injury without fracture and dislocation accompanied with cervical spondylitic myelopathy.Firstly,the posterior spinal canal enlargement by open-door laminoplasty with laminal plates fixation was performed in prone position.After that,the patients were changed into supine position,and the anterior subtotal corpectomy combined with iliac bone grafting and anterior cervical plate fixation was conducted.[Results]The patients had operations performed smoothly without serious complications,and followed up for 12~24 months.At the latest follow up,the numbness symptoms of limbs completely disappeared in 21 patients,while mostly disappeared in 6 patients.All the 27 patients achieved significant improvement in muscle strength in the limbs compared with those preoperatively.[Conclusion]The combined anterior and posterior surgical procedures take advantages of complete decompression to spinal cord both from the front and rear to facilitate recovery of blood supply to the spinal cord and neurological function,shortened therapeutic period,declined recurrence rate and reliable clinical efficacy for cervical spinal cord injury without fracture and dislocation accompanied with cervical spondylitic myelopathy.

关 键 词：颈髓损伤 骨折脱位 脊髓型颈椎病 前路手术 后路手术 

分 类 号：R681.55[医药卫生—骨科学]