颈前路分段减压植骨融合术治疗老年多节段脊髓型颈椎病

Anterior segmental decompression and interbody fusion in the treatment of senile clinical study of cervical spondylotic myelopathy

目的探讨经前路分节段减压植骨融合术治疗老年三节段及以上复杂性脊髓型颈椎病的临床效果。方法选择接受颈椎前路减压椎间植骨融合钛板螺钉内固定术的多节段颈椎病患者50例,收集患者的一般资料和手术时间、术中出血量、术前、术后1 w、术后12个月时的JOA分值以及手术前后的颈椎X光片、CT和MRI。分析临床症状缓解情况和JOA改善率,观察内固定及植骨融合情况,颈椎标准矢状位侧位片Cobb角、融合节段椎体前缘高度(HAB)及后缘高度(HPB)。结果该组病例手术时间90~150 min,平均120 min。出血量150~450 ml,平均325.5 ml。平均随访15.1个月,术后2 w内均感神经症状明显好转,下肢肌力增加,肢体活动较术前明显改善,且双上肢感觉异常基本消失。除3例术前已颈髓损伤严重者,无明显恢复外,其他47例患者神经功能均有不同程度改善;50例术后12个月颈椎正侧位X片提示均可见椎间隙融合,椎间高度及生理弧度维持良好。结论前路分节段减压植骨融合钛板内固定手术是治疗三节段及以上脊髓型颈椎病的安全有效的手术方式,值得提倡。

Objective To explore the clinical effect of anterior segmental decompression and interbody fusion in treatment of elderly patients with three segments and the complexity of cervical spondylotic myelopathy.Methods Patients with titanium plate internal fixation bone fusion underwent anterior cervical decompression and multi segmental cervical spondylosis were collected.Operation time,intraoperative blood loss,JOA score and before and after operation of cervical X ray,CT and MRI before and after 1 week,12 months after operation were selected.Clinical symptoms and the improvement rate of JOA,observation of internal fixation and bone grafting fusion,cervical standard sagittal Cobb angle,lateral fusion segment of vertebral body height(height of anterior border,HAB) and posterior height(height of porterior border,HPB).Results Operation time was 90~150 minutes,average 120 minutes.The amount of bleeding 150~450 ml,average 325.5 ml.Mean follow-up time was 15.1 months.After operation 2 weeks,sympathetic symptoms were improved obviously,lower limb muscle strength was increased,physical activity was significantly improved,and the double upper limbs anesthesia disappeared.In addition to the 3 cases who had serious cervical spinal cord injury had no obvious recovery,the other 47 patients with neurological function were improved.50 cases' X tips at 12 months after operation of cervical vertebrae showed intervertebral fusion,intervertebral height and lordosis maintaining good.Conclusions Anterior segmental decompression and bone graft fusion and titanium plate internal fixation operation is a safe and effective operation for treating the three section and above cervical spondylotic myelopathy,worth recommending.