摘要
为总结并比较不同类型颈椎病的不同手术方法 ,以提高颈椎病的手术治疗效果 ,对采用椎板切除术、椎管成形术、椎体次全切、Cloward术式、Smith术式、Keyhole椎间孔扩大术、椎间盘切除 +植骨融合术、钛钢Cage椎间固定术、Orion钛合金钢板固定术等手术方式治疗的 1780例进行分析。结果 :①脊髓型 36 3例 :椎板切除 4例 ,椎体次全切 136例 ,Cloward术式 2 0 1例 ,Smith术式 4例 ,椎间盘切除+椎间植骨 14例 ,钛钢板椎间固定 4例。随访 10 4例 ,术后优良率 82 7%。②脊髓神经根型 110 6例 :椎板切除 3例 ,椎管成形 14 3例 ,椎体次全切 6 87例 ,Cloward术式 2 6 3例 ,Smith术式 2例 ,椎间盘切除 +椎间植骨 8例。随访 396例 (5 8 4 % ) ,术后优良率 85 6 %。③神经根型 35例 :后方入路Keyhole椎间孔扩大术 19例 ,侧方入路椎间孔扩大术 9例 ,前方入路椎间孔扩大术 7例。术后优良率 10 0 %。④椎动脉型 9例 :钩椎关节骨赘磨除 5例 ,横突孔开放 4例 ,效果均好。⑤食管型 18例 :采用骨赘切除 ,症状消失。⑥后纵韧带骨化型 93例 :椎体次全切 39例 ,椎管成形 4 5例 ,椎板切除 9例。随访 4 1例 ,术后优良率 85 3%。⑦发育性椎管狭小 15 6例 :椎管成形 14 9例 ,椎板切除 7例。随访 82例 ,术后优良率 97 5 %。
Different types of cervical spondylosis treated by a vartiety of operative techniques were compared with the aim at improving quality of treatment for cervical spondylosis. 1780 operations including laminectomy, open door laminoplasty, subtotoal vertebrectomy, Cloward's technique, Smith's technique, 'keyhole' decompression of the intervertebral foramina, discectomy with intervertebral fusion, intervertebral fixation with titanium cage, and fixation with titanium plate. The results showed:(1)Myelopathy in 363 cases: laminectomy on 4; subtotoal vertebrectomy on 136; Cloward's technique on 201; Smith's technique on 4; intervertebral fixed with titanium on 4; discectomy with fusion on 14. 104 cases were followed up, 82 7% of them showed good and excellent recovery. (2)Myeloradiculopathy in 1106 cases: laminectomy on 3; laminoplasty on 143; subtotoal vertebrectomy on 687; Cloward's technique on 263; Smith's technique on 2; discectomy with fusion on 8. 396 cases were fouowed up, 85 6% of them showed good and excellent recovery. (3)Radiculopathy in 35 cases: posterior approach key hole decompression of the intervertebral foramina on 19; lateral approach decompression of the intervertebral foramina on 9; anterior approach decompression of the intervertebral foramina on 7. Good and excellent results reached 100%. (4)Vertebral artery compression in 9 cases: resection of the osteophyte of the uncinate processes on 5; opening of the transverse foramen on 4. The results were good. (5)Esophagus compression in 18: after removing directly the osteophyte, the symptoms disappeared. (6)Ossification of the posterior longitudinal ligament in 93 cases: subtotal vertebrectomy on 39; laminoplasty on 45; laminectomy on 9. 41 cases were followed up, good and excellent recovery was seen in 85 3%. (7)Cervical stenosis in 156 cases: laminoplasty on 149 and laminectomy on 7. Good and excellent recovery was observed in 97 5%. All the results indicated that a variety of operative techniques could be selected depending on the site of the osteophytes. Direct resection of the lesion which produced compression and fixation or fusion of vertebral bodies were both important to achieve a satisfactory result
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2003年第2期168-170,共3页
Medical Journal of Chinese People's Liberation Army
关键词
神经外科手术
颈椎病
手术入路
neurosurgical procedures
cervical spondylopathy
operative approach
