保留椎体后壁的椎体次全切除扩大减压术

Subtotal corpectomy with the posterior vertebral wall retention for the extensive decompression

目的介绍自行设计的保留椎体后壁的颈椎前路椎体次全切除扩大减压术。方法2001年3月至2004年3月,应用保留椎体后壁的椎体次全切除扩大减压术治疗各种颈椎伤病89例,男61例,女28例;年龄25～76岁,平均47岁。其中多节段脊髓型颈椎病伴或不伴神经根型颈椎病62例,颈椎椎体骨折伴或不伴颈椎脱位14例,颈椎不稳症伴或不伴椎间盘突出13例。全部病例均有椎体次全切除指征,其中C423例,C555例,C611例。手术方法为椎体开槽、次全切除,但保留椎体后壁骨质约2mm,行椎间隙扩大减压,将植骨块或钛网嵌于减压槽内,使其与椎体的上下终板、椎体残留侧壁及后壁紧密接触。术后3、6、12个月摄X线片评价内固定在位及植骨融合情况,并记录患者神经功能评分。结果手术时间55￣130min,平均100min;出血量30～300ml,平均120ml。随访6个月以上者77例,均未发生钢板松动及植骨脱落、塌陷。术后Frankel评分平均提高1.0级。所有患者病变节段稳定,无假关节形成,植骨融合。3例出现声音嘶哑,2周后自愈。结论保留椎体后壁的椎体次全切除扩大减压术适用于相邻双节段颈椎病、颈椎骨折椎体后壁完整以及连续两个节段局灶型后纵韧带骨化者,具有操作安全、减压彻底及植骨融合可靠等优点。

Objective To report a newly designed method of cervical subtotal corpectomy with the posterior vertebral wall retention. Methods 89 cases of cervical spondylotic myelopathy （CSM） or cervical injury were treated with subtotal corpectomy with the posterior vertebral wall retention from March 2001 to March 2004.61 males and 28 females, aged from 25 to 76 years（mean, 47 years） were included, which involved 62 cases of multiple level in CSM with or without radiculopathy, 14 fractures of cervical vertebral body with or without cervical dislocation, 13 cervical instability with or without cervical disc disease. Subtotal corpectomy with 2 mm retention in posterior wall of the vertebral body were performed, in which 23 cases level were C4, 55 C5 and 11 C6. Extensive decompression through intervertebral body space was performed and bone fusion with autogenous iliac bone graft or titanium mesh supplemented with anterior locking plates were used, the bone graft or mesh were impacted into the decompression slot between the upper to lower endplate as well as the preserved lateral and posterior wall stably. Bone fusion were assessed with roentgenogram during the 3rd, 6th, 12th month follow-up and neurological function was recorded. Results The average operation time is 100 min, ranged from 55-130min, the blood loss were 120 ml, ranged from 30 to 300 ml. Neither plate or screw migration, nor bone graft loosening or subsidence were found in 77 patients with over 6 months follow-up. Bone fusion happened in all patients, and Frankel score improved 1.0 level averagely after operation. 3 patients with hoarseness recovered 2 weeks later. Conclusion Subtotal corpectomy with posterior wall of vertebrae retention was a feasible anterior decompression procedure with advantage of safety, completely decompression and reliable bone fusion. This method included double level of CSM, and cervical fracture as well as two level of local ossification of posterior longitudinal ligament.