严重颈椎管狭窄症的前后路一期手术治疗

Treatment of serious cervical canal stenosis

目的:探讨严重颈椎椎管狭窄症的治疗方法。方法:对24例严重颈椎椎管狭窄症施行颈后路单开门减压,同时颈前路选择性椎间减压,植入Cage或钛笼,而后行钛板固定术,术后随访观察植骨融合率,椎间高度维持情况及其并发症。结果:24例患者随访平均6个月以上,均获得牢固的骨性融合,脊髓功能明显改善,未发生严重的并发症。按Odom评分标准:非常满意11例(占45.83%),满意10例(占41.66%),基本满意2例(占8.33%),不满意1例(占4.16%),总有效率95.83%,优良率87.5%。结论:前后入路治疗严重颈椎椎管狭窄症明显提高彻底减压及植骨融合率,并有效地维持椎间高度,避免了因骨的再吸收造成椎间塌陷引起的继发神经功能损害,只要严格的掌握手术的适应证,遵循手术的操作原则,绝大多数的手术并发症均可避免发生。因此,该方法在治疗严重的颈椎椎管狭窄症方面是一种较理想的治疗方案。

Objective To observe the methods of serious cervical canal stenosis. Method 24 cases were operated upon with reducing pressure by expansive open-door and selective anterior reducing pressure and anterior cervical interbody fusion (using cage or titanium web), at last with anterior fixing with titanium plate. After operation, we observe the percent of interbody fusion ,distance of interbody and complications. Results 24 cases had been followed up from an average of more than six moths, they all got solid fusion ,function of the spinal cord were improved obviously, no serious complication happened. With the standard of odom, among the cases ,46% is very good,42% is good,8% is general,4% is bad,effective rate is about 96%,excellent rate is about 87.5%. Conclusion The methods of serious cervical canal stenosis are only can reduce pressure thoroughly,but also can keep the stability of cervical vertebrae, improve the rate of interbody fusion,keep the distance of interbody ,so avoid the function injuries of the nerve because of the shortening of interbody caused by reabsorbing of the bones. This procedure is one of the effective operative methods in the treatment of severe cervical canal stenosis.