颈椎前路多节段融合术后邻椎病的再手术策略  

The surgical treatment strategy for adjacent segment disease after anterior cervical discectomy and fusion of multi-segments

作　　者：涂强 孙昊 陈虎[3] 朱昌荣 陈育岳 黄显华 刘永刚 马向阳 王建华 章凯 夏虹 Tu Qiang;Sun Hao;Chen Hu;Zhu Changrong;Chen Yuyue;Huang Xianhua;Liu Yonggang;Ma Xiangyang;Wang Jianhua;Zhang Kai;Xia Hong(Department of Orthopedics,General Hospital of Southern Theatre Command,Guangzhou 510010,China;The Southwest Hospital of Army Medical University,Chongqing 400038,China;Graduate School,Southern Medical University,Guangzhou 510515,China;Graduate School,Guangzhou University of Chinese Medicine,Guangzhou 510000,China)

机构地区：[1]中国人民解放军南部战区总医院骨科,广州510010 [2]陆军军医大学第一附属医院,重庆400038 [3]南方医科大学研究生院,广州510515 [4]广州中医药大学研究生院,广州510000

出　　处：《中国临床解剖学杂志》2023年第2期218-223,共6页Chinese Journal of Clinical Anatomy

基　　金：军队医学科技青年培育计划孵化项目(NO.19QNP040);广州市科技计划项目(NO.202102021254);军队后勤科研计划项目(CLB20J033)。

摘　　要：目的探讨颈椎前路多节段融合术后邻椎病的手术治疗策略。方法对2015年至2020年我院收治的13例颈椎前路多节段融合术后邻椎病再手术治疗的患者进行回顾分析,采取颈椎前路Zero-P钢板固定术治疗8例单节段邻椎病,后路颈椎单开门椎管扩大成形术治疗5例2个节段邻椎病,采用JOA评分、VAS评分及NDI指数进行疗效评价,分析X线、CT或MRI影像学表现。结果本组所有病例得到随访,平均随访11.6个月(6~24个月)。两种术式术后患者JOA评分、VAS评分、NDI指数均得到显著改善。颈椎前路Zero-P钢板术后内固定物位置良好,随访未见钢板螺钉松动,骨融合平均时间为7.6个月。颈椎后路单开门椎管扩大成形术治疗患者均未出现C5神经根麻痹、椎板再关门等并发症。结论颈椎前路多节段融合术后邻椎病再手术方式的选择应遵循个体化原则,单节段邻椎病且不伴严重后纵韧带骨化,可选择前路减压融合Zero-P固定术;邻椎病变节段≥2处,可选择后路单开门椎管扩大成形术。Objective To explore the surgical treatment strategy for adjacent segment disease(ASD)after anterior cervical discectomy and fusion of multi-segments.Methods From 2015 to 2019,13 patients with ASD in our hospital were retrospectively analyzed.Eight patients were treated with anterior cervical Zero-P plate and 5 patients were treated with single-door laminoplasty.JOA,VAS,and NDI were noted to evaluate the clinical outcomes,and X-ray,CT,and MRI imaging were recorded and analyzed as well.Results All the patients were followed up for an average of 11.6 months(6~24 months).The JOA,VAS and NDI were significantly improved after both surgeries.In the anterior cervical operation group,the position of the internal fixation was good and no loosening of the plate screw was observed during follow-up.The average time of bone fusion was about 7.6 months.In patients who were treated with single-door laminoplasty,there were no complications such as C5 nerve root palsy,lamina re-closing and so on.Conclusions The selection of reoperation methods for ASD after multilevel anterior cervical fusion should follow the principle of individualization.For single-level ASD without severe posterior longitudinal ligament ossification,anterior decompression and fusion with the Zero-P system should be selected.For multi-levels ASD,the posterior single-door laminoplasty is preferred.

关 键 词：颈椎融合术 邻椎病 前路 后路 再手术 

分 类 号：R681.5[医药卫生—骨科学]