摘要
目的探讨多节段脊髓型颈椎病（CSM）的个性化手术治疗方法及疗效。方法 2002年2月~2010年2月CSM患者98例,男57例,女41例,3节段78例,4节段20例。采用颈椎前路两节段椎体次全切除钛网植骨、钛板内固定术53例;前路单节段减压人工椎间盘置换术结合单椎体次全切除钛网植骨钛板内固定术18例;颈后路椎管扩大成形椎弓根钉植入固定术27例。术后复查X光片,观察植骨融合稳定情况,采用JOA评分评价神经功能。结果手术时间：前路90~140 min,平均120 min;后路120~220 min,平均170 min。术中出血量：前路手术130~600 mL,平均200 mL;后路手术200~800 mL,平均650 mL。术后随访12~36个月,平均24个月,全部病例均获骨性融合,融合时间3~9个月,平均6.5个月。颈椎前路：术前JOA评分为（5.8±3.2）分,末次随访JOA评分为（13.2±2.1）分,与术前比较差异有显著性（P〈0.01）,术后改善率为（74.5±18.2）%,优良率为90.1%;颈椎后路：术前JOA评分（4.0±2.8）分,术后末次随访JOA评分（14.2±3.2）分,与术前比较有显著性差异（P〈0.01）,改善率为（70.3±12.0）%,优良率为86.3%。前路后路手术JOA改善率比较没有显著性差异（P〉0.01）。结论多节段颈椎间盘突出或其他退变性的因素所致的脊髓型颈椎病,根据临床症状和体征结合MRI影像学改变,采用个性化的手术减压、植骨融合内固定术可获得满意的疗效。
【Objective】 To investigate the efficacy of personalized surgery for multi-segmental cervical spondylotic myelopathy（CSM）. 【Methods】From February 2002 to February 2010, a total of 98 cases（male 57, female 41） were received operation. There were three segments in 78 cases, four segments in 20 cases. Respectively, anterior cervical decompression, two vertebral body subtotal decompression, titanium mesh cage and plate fixation were performed in 53 cases; Single segmental decompression combined with artificial disc replacement were performed in 18 cases. Posterior laminoplasty and pedicle screw fixation were performed in 27 cases. Postoperative X-rays were used to observe bone fusion and spinal stability. JOA score was used to evaluate never function. 【Results】The operative time： anterior were 90~140 minutes, an average of 120 minutes; posterior were 120~220 minutes, an average of 170 minutes. The bleeding volume： the anterior operations were 130~600 mL, an average of 200 mL; posterior operations were 200 ~800 mL, an average of 650 mL. All patients were followed up for 12 ~36 months, an average of 24 months, all the patients were bone fusion, fusion time were within 3~9 months, an average of 6.5 months. Anterior group： preoperative JOA scores were（5.8 ± 3.2） points, the final follow-up JOA scores were（13.2 ± 2.5） points（P 0.01） compared with the preoperative, the postoperative improvement rate was（74.5±18.2）%, and the excellent rate was 90.1%; posterior group： preoperative JOA scores were（4.0 ± 2.8） points, the final follow- up JOA scores were（14.2 ± 3.2） points（P 0.01） compared with the preoperative, the postoperative improvement rate was（70.3 ± 12.0）%, and the excellent rate was 86.3%. The JOA improvement rate had no significant difference between two groups. 【Conclusions】The treatment of CSM which was caused by multi-segment cervical disc or other degenerative factors should based on clinical symptoms and signs combining MRI imagines. The individual surgical decompression, inter-body fusion and internal fixation can get satisfactory efficacy.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2013年第33期51-54,共4页
China Journal of Modern Medicine
关键词
脊髓型颈椎病
多节段
前路减压术
后路减压术
cervical spondylotic myelopathy
multi-segment
anterior decompression
posterior decompression
