颈前路分段开槽减压融合术治疗多节段脊髓型颈椎病

Treatment of multi-level involoved cervical spondylotic myelopathy by anterior cervical decompression with sectile trough technique and autograft fusion

目的:探讨颈前路分段开槽减压融合术治疗多节段脊髓型颈椎病的效果。方法:回顾性分析自2001年4月至2004年1月期间,采用前路分段开槽减压法治疗并获随访的21例多节段脊髓型颈椎病患者的临床资料,根据术前、术后即刻、随访时的颈椎标准侧位X线片,测量融合节段的前凸或者后凸Cobb角,同时测量融合节段椎体前缘高度(HAB)、后缘高度(HPB),并观察植骨融合情况;以JOA评分评估神经功能改善情况。结果:经9￣24个月(平均14.2个月)随访,所有病例内置物无松动、移位。术后JOA评分平均改善率为72.2%,其中优9例,占42.9%;良7例,占33.3%;中3例,占14.3%;差2例,占9.5%。术后即刻融合节段HAB、HPB及Cobb角较术前有明显改善(P<0.01),术后9个月HAB、HPB及Cobb角与术后即刻无显著性差异(P>0.05)。结论:前路分段开槽减压融合术能够兼顾减压及稳定性重建,是治疗多节段脊髓型颈椎病的有效方法。

Objective：To investigate a novel operative method in the surgical treatment of multi-level cervical spondylotic myelopathy （CSM）.nethod：21 cases of multi-level CSM underwent the novel operation between April 2001 to Jan 2004 were retrospectively analyzed.M1 patients underwent the operation of anterior cervical decompression by sectile trough technique,autograft fusion and internal fixation.Preoperative,immediate postoperative and follow-up X-ray films and JOA scores were utilized to evaluate the restoration of lordosis （Cobb＇s angle）,intervertebral height （height of anterior border,HAB;height of posterior border,HPB）,and stability of cervical spine and the improvement of neurological impairment.Result：Preoperative symptoms obviously alleviated or disappeared in most patients.According to JOA score,the ratio of improvement in neurological function was 72.2%,including excellent in 9 cases（42.9%）,good in 7 cases（33.3%）,fair in 3 case（14.3%） and bad in 2 cases （9.5%）.Immediate postoperative X-ray films showed the obvious improvement in lordosis and intervertebral height of the cervical spine（P〈0.01） and no loss（P〉0.05） during the mean follow-up 14.2 months（9- 24 months）,and no instrument failure was detected,Conclusion：The operative method of anterior cervical decompression by sectile trough technique,autograft fusion and internal fixation is a rational and effective method for the surgical treatment of multi-level CSM.