脊髓型颈椎病前路手术的神经学评价和疗效影响因素

Neurologic evaluation and curative effect facts of cervical spondylotic myelopathy anterior decompression and fusion

[目的]探讨脊髓型颈椎病神经学评价标准和疗效影响因素。[方法]对21例脊髓型颈椎病的患者术前和术后实施Nurick分级法、JOA评分以及我国的40分评估法,并评价各种方法的优缺点。对影响神经学功能恢复的可能因素加以分析。[结果]平均随访11个月,术后Nurick颈椎病脊髓功能分型提高2～3级。JOA评分提高1～6分;我国的40分法提高7～12分。影响脊髓型颈椎病的手术技术因素有:椎体后缘骨赘切除不全、颈椎生理弧度恢复不良、椎体高度撑开不足或术后的过度丢失。[结论]Nurick分类允许更严格的比较,对某些脊髓病并不适合;JOA评分方法简便、有效,能较为全面地反映脊髓型颈椎病脊髓功能的改变;40分评定方法评价较为客观,但较为繁琐。椎体后缘骨赘切除不全和椎体高度撑开不足与手术疗效关系最为密切。

[ Objective ] To study the neurologic criterion and curative effect facts of cervical spondylotic myelopathy. [ Method] A prospective study was carried out and 21 cases of cervical spondylotic myelopathy were involved in this investigation to be classified by Nurick grade, JOA score and 40 cent classification. The possibility curative effect facts were analysed. [ Result] The patients were followed up for average 11 months. Spinal cord function score were improved by 2 - 3 grades according to Nurick grade; 1-6 cent to JOA score and 7 - 12 cent to 40 cent postoperation. Height of vertebral, cervical lordosis, centrum posterior decompression being unenough, excess height of centrum were curative effect facts of cervical spondylotic myelopathy. [ Conclusion ] Nurick classify allow even more contrast, but unsuit to some Cervical spondylotic myelopathy, JOA is simple and convenit, efficienf and across-the-aboard; 40 cent assess measure is impersonality but coekamamie. Height of vertebral and centrum posterior decompression being unenough are most important facts about surgery.