颈椎前路减压植骨融合术后颈椎后凸畸形的原因分析

The mechanism of cervical kyphosis after anterior cervical decompression with bone graft fusion

目的:探讨颈椎前路椎体植骨融合术后颈椎后凸畸形的原因.方法:随诊1982年8月～2000年12月274例行颈椎前路减压、单纯植骨融合术的病例,对其中确诊为颈椎后凸畸形患者的手术减压节段、植骨方式、骨融合情况及术后颈椎后凸畸形的进展对疗效的影响进行分析.结果:随访2年3个月～7年6个月,平均4年1个月,17例患者确诊为颈椎后凸畸形;术后1年时融合节段前柱短缩明显,颈椎后凸畸形最明显,其中12例为双节段减压、Keystone式植骨;8例后期颈椎植骨融合节段上下相邻椎体不稳.17例患者术前JOA评分平均10.2分,术后1年平均15.2分,末次随访时为15.6分.结论:单纯颈椎前路减压植骨融合术后因减压节段和植骨方式的不同使融合节段前柱短缩及植骨融合节段上下相邻椎体不稳是颈椎后凸畸形的直接原因.

Objective:To investigate the mechanism of cervical kyphosis after anterior cervical bone graft fusion.Method:274 cases from 1982 Aug. to 2000 Dec. treated with anterior cervical decompression and bone graft fusion were reviewed.Cervical kyphosis in 17 cases were verified after operation.The influences on operation effect were analysed by studing segment of decompression,method of bone graft,condition of bone graft fusion and progress of kyphosis after operation.Result:The follow-up was 4 years and 1 months on average(2 years and 3 months to 7 years and 6 months),12 cases were treated with double segment decompression and Keystone method of bone graft.All cases had bone fusion healing within 6 months,anterior column of bone fusion segment became compression and short apparently in 1 year,cervical kyphosis was most obvious.The adjacent segment of cervical bone graft fusion became instable in 8 cases later on.The average JOA score was 10.2 before operation and 15.2 at one year follow-up after operation,the latest JOA score was 15.6.Conclusion:The direct reason of cervical kyphosis for simple cervical anterior decompression with bone graft fusion is the compression and short of the anterior column and the instable adjacent segment of bone graft fusion caused by the difference of decompression segment and method of bone graft fusion.