颈前路减压支撑融合钢板内固定术治疗脊髓型颈椎病

Anterior cervical decompression and interbody fusion with plate internal fixation for the treatment of cervical spondylotic myelopathy

目的探讨颈前路减压、椎体间植骨支撑融合或颈椎椎间融合器(钛网或Cage)支撑融合、钢板内固定术治疗脊髓型颈椎病的临床方法及疗效。方法回顾分析66例脊髓型颈椎病患者行颈前路减压后,分别采取骼骨植骨支撑融合、颈椎间融合器(钛网或Cage)植入支撑融合,钢板内固定术,随访时间平均32个月,采用Zdeblick影像学判定椎体间融合的标准,贾连顺的评定法评定术后临床疗效。结果在颈前路减压、钢板内固定术治疗脊髓型颈椎病方法中,自体骼骨植骨融合优良率87.5%,供区并发症12.1%,椎间盘退变椎间高度丢失7.6%;颈椎间融合器支撑融合优良率96.1%,无供区并发症和椎间盘退变椎间高度丢失。结论颈前路减压、椎体间植骨融合或颈椎间融合器支撑融合、钢板内固定术治疗脊髓型颈椎病临床疗效满意。钢板内固定术后颈椎即刻稳定;植骨融合手术操作简单,费用少,但存在供区并发症、椎间高度丢失;椎间融合器融合稳定、牢固,椎间高度丢失少,后者疗效优于前者。

Objective To investigate the clinical methods and effects of anterior cervical decompression, interbody fusion with bone graft or with titanium mesh or cage and plate internal fixation for cervical spondylotic myelopathy. Methods Sixty- six patients of cervical spondylotic myelopathy underwent anterior cervical decompression, then interbody fusion with auto-ilium graft or with titanium mesh or cage, and plate internal fixation. All patients were followed up for 32 months.on average. The criterion of interbody fusion was estimated by Zdeblick＇ s imaging standard and the clinical effect by Jia Lianshun＇ s evaluation method. Results Of the treatment of anterior cervical decompression with plate internal fixation, to interbody fusion with auto-ilium graft, fine rate was 87.5% , incidence of donor-site complication was 12.1% and intervertebral height lost for degeneration of intervertebral disc was 7.6%. To cervical interbody fusion with titanium mesh or cage, fine rate was 96. 1% without donor-site complication or intervertebral height lost for degeneration of intervertebral disc. Conclusion The clinical results of anterior cervical decompression, interbody fusion with bone graft or with titanium mesh or cage and plate internal fixation for cervical spondylotic myelopathy are both satisfactory. Cervical spine can get stability immediately after plate internal fixation. The procedure of inerbody fusion with bone graft is simple and the cost is lower, but there are donor-site complication and intervertebral height lost. However, cervical interbody fusion with titanium mesh or cage is stabler and firmer with less intervertebral height lost. So the effect of the latter is better than that of the former.