颈前路手术治疗4个节段脊髓型颈椎病的中期疗效分析  

The mid-term clinical outcome of anterior surgical in the treatment of 4-level cervical spondylotic myelopathy

作　　者：饶敏杰 严宁[2] 侯铁胜[2] 张功恒 甘心荣 徐文华 曹盛生 RAO Minjie;YAN Ning;HOU Tiesheng(Department of Orthopaedics,the People's Hospital of Yichun City,Yichun,Jiangxi,336000,China)

机构地区：[1]宜春市人民医院骨科/宜春市脊柱外科重点实验室,336000 [2]同济大学附属第十人民医院骨科,上海市200072

出　　处：《中国脊柱脊髓杂志》2020年第4期346-352,共7页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:探讨颈前路手术治疗4个节段脊髓型颈椎病的中期临床效果及其并发症分析。方法:回顾性分析2013年9月~2016年10月,行颈椎前路手术治疗的4个节段脊髓型颈椎病31例患者资料,男18例,女13例,年龄54~74岁,平均58.1±4.9岁,对所有患者进行随访,采用疼痛视觉模拟评分(visual analogue scale,VAS)评估颈肩肢体疼痛情况,日本骨科协会(Japanese Orthopedic Association,JOA)评分评估患者神经功能恢复情况,行颈椎正侧位及过伸过屈位X线片,观察钛网等内固定情况,测量C2~C7颈椎椎体高度和颈椎生理曲度,评估植骨融合情况。并记录患者手术相关并发症。结果:27例患者获得随访,随访时间为35~72个月,平均52.7±3.6个月。末次随访时VAS为1.6±0.6分,低于术前的7.2±1.5分,差异有统计学意义(P<0.001)。末次随访JOA评分为16.1±4.2分,高于术前的8.8±3.7分,差异有统计学意义(P<0.001)。至末次随访时,患者颈椎椎体高度及颈椎曲度较术前均有明显改善,差异有统计学意义(P<0.001)。所有患者均获得骨性融合,27例患者共出现19例次并发症,脑脊液漏3例,一过性吞咽困难2例,轴性症状1例,C5神经根麻痹2例,邻近节段退变6例,钛网下沉2例,内固定松动、移位2例,螺钉断裂1例。结论:颈前路手术治疗脊髓前方受压为主的4个节段脊髓型颈椎病,能有效恢复颈椎高度和维持颈椎曲度,其中期疗效满意。Objectives:To investigate the mid-term clinical results and the complications of patients with 4-level cervical spondylotic myelopathy who underwent anterior decompression and fusion surgery.Methods:Between September 2013 and October 2016,31 patients of 4-level cervical spondylotic myelopathy who underwent anterior cervical surgery were included.There were 18 males and 13 females,whose mean age was 58.1±4.9 years old(range,54-74 years).The neck and shoulder pain were evaluated by visual analogue scale(VAS),and neurological function measured using Japanese Orthopedic Association(JOA)scores.X-rays were conducted before and after surgery for cervical height,physiological curvature of C2-C7 and fusion rate.Complications of the patients were recorded and analyzed as well.Results:27 cases completed the follow-up.The mean follow-up time was 52.7±3.6 months(35-72 months).At final follow-up,the VAS scores reduced from preoperative 7.2±1.5 points to 1.6±0.6 points(P<0.001),and the JOA scores increased from preoperative 8.8±3.7 points to 16.1±4.2 points(P<0.001).At final follow-up,the cervical height and physiological curvature showed significant improvement compared with pre-operation(P<0.001).The fusion rate was 100%.15 patients presented with related complications,including 3 cases of cerebral fluid leakage,2 cases of temporary dysphagia,1 cases of axial neck pain,4 cases of C5 palsy,6 cases of adjacent segment diseases,2 cases of graft subsidence,2 cases of looseness and displace of the internal fixation and 1 case of screw extraction.Conclusions:Anterior cervical surgery for 4-level cervical spondylotic myelopathy is a challenging surgical technique,restoring the height of cervical vertebra and the curvature of cervical vertebra,with good results for the mid-term efficacy of clinical effects.

关 键 词：颈前路手术 脊髓型颈椎病 中期疗效 手术并发症 

分 类 号：R683.2[医药卫生—骨科学] R619[医药卫生—外科学]