椎间融合器颈椎前路钻孔减压融合术治疗颈椎病

Cloward's decompression and fusion with interbody cage for the treatment of cervical myelopathy

目的探讨使用椎体间融合器的钻孔减压融合术治疗脊髓型颈椎病的原理、手术技术、治疗效果和适应证。方法Cloward钻孔减压和潜行减压后于孔内旋入笼式融合器,术后戴颈围固定3周,每隔3个月复查1次,拍照X线片观察融合器固定情况和移植骨成活、融合情况。共给46例患者施行手术。结果平均手术时间55min;术中出血量120ml。术后平均随访19个月。38例术后症状、体征完全消失或明显改善。所有患者均获融合,平均融合时间12个月。未见融合器下沉。结论本手术设计能在满足减压要求的前提下保证力学上的支撑和固定要求,又能提供生物力学上移植骨的成活、融合所需的环境。设计是合理的、相对完善的。与椎体切除槽型减压加钢板固定术相比,本手术有如下优点:创伤少、操作简单、固定可靠、不用从髂骨取骨,术后康复快等。

Objective To investigate the rationale, surgical technique, effectiveness and. indications of the treatment for cervical myelopathy by Cloward＇s decompression and interbody fusion with fusion cage. Methods A fusion cage was threaded into the hole after Cloward decompression and extended decompression. A collar was recommended for three weeks postoperatively. Photography was given every three months to evaluate the state of fixation of cage and healing of bone graft. A total of 46 patients had been performed on with the surgery. Results The mean operating time and blood loss were 55 minutes and 120ml. The follow-up range averaged 19 months. Thirty-eight of the patients had complete or significant symptom relieve. Fusion occurred in all of the patients and it took an average of 12 months. No cage subsidence took place. Conclusion The design can meet the demands for decompression firstly, and for support, fixation mechanically, furthermore for biological conditions for survive and fusion of bone graft. It is reasonable and improvable. While compared to corpectomy and plate fixation,the technique had the advantages of less trauma ,more friendly manipulation, secure fixation, no need to harvest bone from ilium and rapid recovery.