摘要
[目的]探讨颈椎病伴椎管狭窄时的治疗策略及手术入路选择，为颈椎病手术治疗提供有益的经验。[方法]通过收集2002年7月～2003年12月间颈椎病伴椎管狭窄经前路减压术后疗效不佳或症状复发的病例，经分析后再次行后路减压手术治疗并观察其近期疗效；同时随机抽取1985年4月～1992年5月间病情相似而行后路减压的一组病例进行远期疗效随访，对比两组术后疗效。[结果]经前路减压术后脊髓功能（JOA）改善率仅为11．7％，但经后路者为70．3％；而前者经后路减压再手术后脊髓功能改善率可提高至52．8％。[结论]颈椎病伴颈椎管狭窄病例经前路减压术后疗效不佳或症状复发的主要原因在于椎管狭窄因素仍然存在，对上述病例行后路减压再手术治疗后，仍可取得一定的疗效；而最初便经后路减压治疗的此类患者则可取得较显著的远期疗效，提示经后路多节段减压可一期有效地扩大颈椎椎管，从而提高手术治疗颈椎病的疗效。
[ Objective ] To discuss the strategy of surgery and the choice of surgical approaches for cervical spondylotic myelopathy with stenosis of cervical spinal canal in order to offer helpful experience to the treatment of cervical spondylotic myelopathy. [Method] The cases of cervical spondylotic myelopathy with stenosis of cervical spinal canal which had poor outcome, or recurred decompressed by anterior approach during the period of Jul. 2002 to Dec. 2003 were collected, and after analyzing, another decompression by posterior approach were performed and the short-term follow-up were undergone ; meanwhile, the patients in the similar condition but by posterior approach only during the period of Apr. 1985 to May. 1992 were drawn randomly, and the long-term follow-up were carried out, and the results were compared. [ Result] The recovery rate of the spinal cord function in the patients who were decompressed by anterior approach was only 11.7%, but the posterior one was 70. 3%, and the recovery rate of the former patients decompressed again by posterior approach improved to 52. 8%. [ Conclusion] The main cause of poor outcome, or recurrence decompressed by anterior approach lies in the stenotic factors of spinal canal still existing, and good outcome can still be obtained in a certain extent when another surgical decompressions by posterior approach were performed. However, the patients decompressed by posterior approach initially have achieved a much better outcome in the long-term followed-up. All these indicate that the decompression by posterior approach can enlarge the cervical spinal canal efficiently in one-stage, and improve the curative effect for surgical treatment of cervical spondylotic myelopathy indeed.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2006年第9期653-656,共4页
Orthopedic Journal of China
关键词
脊髓型颈椎病
椎管狭窄
后路
外科治疗
Cervical spondylotic myelopathy
Stenosis of spinal canal
Posterior approach
Surgical treatment
