摘要
目的评价前后路联合减压内固定术治疗脊髓型颈椎病的临床效果,总结手术并发症的防治措施。方法回顾性分析28例脊髓型颈椎病行前后路联合椎管减压内固定术的临床效果及并发症。其中患者身体状况良好,或是钳夹型脊髓型颈椎病,先行后路减压,改变体位后,再行前路减压融合内固定术,一期前后路联合手术6例;前后路分期手术22例。定期随访,临床效果按照 JOA 评分以及 Odom 评分进行评价,X 线片观察颈椎融合效果。结果患者的伤口均一期愈合,无神经系统损伤,24/28获得随访,平均随访16个月(6～52个月),大多数患者的脊髓功能有不同程度的进一步改善,出院时 JOA 评分改善率为50%。根据 Odom 分级评定法,优良率为83.3%。术后3～6个月颈椎椎间融合均获得愈合,尚未发现内固定失败病例,没有患者需要进行针对手术节段的再手术。术后3例发生脑脊液漏,经保守治疗痊愈。结论前后路联合减压内固定术是治疗严重、多节段脊髓型颈椎病的有效方法之一,但是,手术创伤较大,内固定操作复杂,应谨慎设计手术方案,预防并发症。
Objectives To evaluate the clinical results of treatment of cervical spondylotic myelopathy by decompression of spinal canal and internal fixation with the combination of anterior and posterior approaches, and to study the methodology to prevent operative complications. Methods 28 consecutive cases with cervical spondylotic myelopathy, aged 65.3 （49 - 73） were treated by decompression of spinal canal and internal fixation with the combination of anterior and posterior approaches from December 2001 to December 2005. The surgical methods included decompression of spinal canal, spinal fusion, and internal fixation with the combination of anterior and posterior approaches. The patients were followed up for 16 months （6 - 52 months）. The clinical results and complications were analyzed retrospectively. The clinical effects were evaluated by the Japanese Orthopedic Association （JOA） scoring system and Odom＇s criteria. The outcome of cervical spinal fusion was evaluated by X-ray plate. Results There were no neural injury and wound healing problems in all patients. All postoperative patients ambulated three days after the operation. CSF leak occurring in 3 cases was cured by conservative treatment. The recovery rate by the JOA scoring system was 50% when the patients were discharged. According to the Odom scoring system, 83.3% of the patients had excellent and good effects. No evidence of implant failure was found according to the Brantigan＇s criteria. Interbody fusion was achieved in 3 - 6 months after operation in all followed-up patients. No additional operation was needed for the involved segments, the spinal cord function of the patients had been improved in a certain extent, and the surgical outcomes could be maintained. Conclusion Decompression of spinal canal and internal fixation with the combination of anterior and posterior approaches is necessary and effective in the treatment of severe and multi-level cervical spondylotic myelopathy, but the operative trauma is relatively serious, surgeons must carefully design the operative plan and pay enough attention to the methods to prevent operative comphcations, especially for the elderly patients.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2007年第1期28-31,共4页
National Medical Journal of China
关键词
颈椎病
椎管狭窄
内固定器
Cervical spondylesi
Spinal stenosis
Internal fixators
