颈椎后-前路联合手术治疗高危颈椎病临床观察

Clinical observation of combination of cervical posterior-anterior decompression with reconstruction operation for the treatment of high risk cervical syndrome

目的观察高危颈椎病的诊断及其颈椎后前路手术治疗高危颈椎病的疗效。方法对42例符合拟定的高危颈椎病患者行后前路颈椎手术治疗,2例轻微外伤后不全瘫的高危颈椎病患者均行Ⅰ期后前路联合手术,余40例患者中分期行后前路颈椎手术10例,Ⅰ期手术30例。后路采用“双开门”椎管成形减压术,前方植骨均为自体三面皮质髂骨,均加颈椎前自锁钛板固定。以手术前后的JOA评分评价手术疗效。结果全部患者获得随访,随访时间6～30月,无伤口感染,未见颈椎内固定及植骨块松脱,术后4月X线复查示前方植骨块与椎体融合。依照JOA评分法,42例患者平均12.5分。手术前平均评分、神经功能均改善,优11例,良18例,好转10例,无效3例。手术有效率为92%(39/42),优良率为61%(29/42)。结论颈椎病的MRI矢状面可见节段性的脊髓前后受压,脊髓的形状变成月牙形甚至线形;横截面脊髓面积减少50%以上的影像学特征加病史、临床症状、体征中任一项即可以确诊为高危颈椎病。颈椎后前路手术治疗高危颈椎病使颈脊髓得到直接的较充分的减压,降低了前方手术操作引起脊髓损伤的风险,为脊髓形状的复原、血供的改善及其功能的恢复提供了有利条件。

Objective To explore the therapeutic effect of combination of cervical posterior-anterior decompression with reconstruction operation for the treatment of high risk cervical syndrome. Methods Combination of cervical posterior-anterior decompression with reconstruction operation for the treatment of high risk cervical syndrome was performed in 42 cases. 2 patients of incomplete paralysis caused by slight trauma underwent Ⅰ stage cervical posterior-antcrior operation, 10 patients of the rest 40 cases underwent operation according to staging and other 30 cases underwent Ⅰ stage of that. Double opening-door laminoplasty was conducted in posterior operation and anterior graft was from autologous cortical iliac bone with titanium plate for internal fixation. JOA score was used to evaluate thc curative effect. Results All patients wcrc followcd up for 6-30 months, finding no wound infection, and no internal fixation breakage and looscning. X-ray 4 months aftcr operation showed autograft fusion. According to JOA the average score was 12.5. Preoperative average score and nerve function improvement were classified as excellent in 11 cases,bettcr in 18 cases and no effect in 3 cases. The effective rate was 92% （39/42） ,with excellent outcome of 61% （29/42）. Conclusion MRI of cervical syndrome has typical ＂washboard＂ pattern ; 50 % decrease of cervical spinal cord transversal area plus shapc of transversal spinal cord like meniscus with sign or symptom can be used to diagnose high risk cervical syndrome. Combination of cervical operation can directly decompress from anterior and posterior aspect, which can reduce the risk of spinal injury caused by anterior procedure and contribute to the reconstruction of the spinal shape ,improvement of blood supply and the function recovery of spine cord.