颈椎前路融合术治疗下颈椎不稳定

Anterior fusion for unstable lower cervical spine

目的评价颈椎前路融合术治疗下颈椎不稳定的临床效果。方法2000年10月至2004年10月,对67例X线片显示颈椎不稳定并伴有相应临床症状的颈椎病患者进行了前路融合手术,其中男性38例,女性29例;平均年龄33岁。颈椎不稳的X线判定标准为颈椎最大前屈和最大后伸侧位X线片测量相邻节段水平位移超过3.5mm或相邻椎体间成角大于11°者。手术方法为椎间植骨+钢板固定或融合器植骨融合。结果所有患者平均随访11个月,不稳椎节均得到融合稳定。大部分患者的术前症状获得了不同程度的改善,脊髓功能JOA评分由术前10.15增至术后14.95,差异有统计学意义(P<0.05);并发症包括术后钢板螺钉松动拔出2例,行翻修手术后恢复满意。结论对下颈椎不稳定患者,合理选择颈椎前路融合方法可获得满意的临床效果。

Objective To assess the clinical outcome of anterior fusion for unstable lower cervical spine. Methods From October 2000 to October 2004, anterior fusion were performed for 67 cases with unstable lower cervical spine with corresponding clinical manifestations. There were 38 males and 29 females with an average age of 33 years. Instability of lower cervical spine was radiographically determined by sagittal plane displacement between 2 cervical vertebrae of more than 3.5 mm or relative sagittal plane angulation greater than 11° on maximal lateral flexion and extention films. Anterior interbody fusion methods included bonegrafting with plate fixation or cage. JOA rating system was used for spine cord function assessment. Results All patients were followed up for an average period of 14 months. Solid fusion was achieved for all operated levels. The majority of the patients got a satisfactory relief of preoperative symptoms. JOA scores for cord function improved from preoperative 10. 15 to postoperative 14.95 with statistical difference （ P 〈0. 05 ）. Complications included screws loosing and backout in 2 cases. Revision surgery were performed with uneventful recovery. Conclusion Satisfactory clinical outcome can be achieved by proper selection of anterior fusion methods for patients with unstable lower cervical spine.