脊髓型颈椎病的术式选择及疗效

OPERATIVE SELECTION AND CURATIVE EFFECT OF CERVICAL SPONDYLOSI

1980年～1990年收治并随访脊髓型颈椎病155例,其中行椎板切除减压术26例,“单开门”椎管成形术18例,用切骨刀、刮匙行前路椎间盘切除植骨术57例,用气动磨钻行前路扩大开窗减压植骨术54例。术式选择:①2个节段以内的颈椎间盘脱出行前路手术;②3个节段以上突出物不超过1/3椎管矢状径者行后路手术;③突出小于1/3矢状径且合并椎管狭窄者行后路手术;④突出超过1/3矢状径合并椎管狭窄者,应行2次手术,并依颈髓受压情况选择先行前路或后路手术。⑤后纵韧带骨化、椎管狭窄者适于后路手术。用气动磨钻的扩大开窗减压优于用切骨刀、刮匙的椎间盘切除。“单开门”椎管成形术疗效优于椎板减压术。

To cure cervical spondylosis, operation were performed on 155 cases including lamincctomy and decompression (26 cascs),one-door-opener plastic operation of widened vertebral canal (18 cases),resection and grafts of anterior intervertebral disc using osteotomy knife and curet (57 cases), anterior window-enlarged decompression and grafts using pneumatic abrasive bur (54 cases).Anterior operation were performed on the protrusions of intervertebral disc within two segments posterior operation were performed on over three segments with the protrusion below one-third sagittal diameter in ve- rtebral canal, or the protrusion below one-third with cervical spinal canal stenosis, or the ossification of posterior longitudinal ligament and the cervlcal stenosis, and that two operations had to be performed if the protrusion over one-third with the cervical stenosis. The curative effects of window-enlarged operation with bur (excellent and good results of 70.4%) were superior to that of resecting the disc with knife and curet (47.4%) . The curative results of door-opened plastic operation (66.8%) were better than that of Laminectomy (46.2%).