前路椎间融合器在多节段脊髓型颈椎病治疗中的应用

Clinical application of anterior cervical interbody fusion cage for multiple level cervical spondylotic myelopathy

目的评价前路椎间盘切除和椎间融合器（cage）植入在多节段脊髓型颈椎病治疗中的应用。方法回顾性分析2003年4月至2006年2月治疗的38例多节段脊髓型颈椎病患者。男35例，女3例；年龄43-72岁，平均56岁。两节段病变36例，三节段病变2例；其中C3.4并C4．5 3例，C4．5并C5．615例，C5．6并C6．718例，C4.5小C5．6并C6．72例。所有患者均行前路颈椎间盘切除、椎间融合器植入手术治疗，合并失稳者加用钛板固定。记录手术时间、出血量。以日本骨科学会（Japanese Orthopedic Association，JOA）评分系统为疗效评价标准，记录患者术前、术后2周、3个月、6个月、12个月时的JOA评分分值并计算改善率。结果38例患者共随访6-34个月（平均25个月）。所有患者在术后2周内均感到神经症状有明显好转，下肢肌力增加，肢体活动度较术前明显改善，且双上肢感觉异常基本消失。JOA评分由术前平均（9．2±0．3）分，提高到术后2周平均（12．4±0．3）分，术后3个月平均（13．2±0．3）分，术后6个月平均（13．8±0．2）分，术后12个月平均（14．2±0．2）分。术后6个月随访时JOA评分改善率：优12例，良18例，可5例，差3例。结论多节段椎间盘切除加椎间融合器植入具有操作简单、出血少、减压充分、植骨融合率高等优点，是治疗多节段脊髓型颈椎病的较好方法。

Objective To evaluate clinical application of anterior multiple level discectomy and interbody fusion cage implant in multiple level cervical spondylotic myelopathy. Methods From April 2003 to February 2006, 38 patients of cervical spondylotic myelopathy were retrospectively analyzed, including 35 males and 3 females, with the mean age of 56 years （range, 43-72 years）. 36 cases with two spaces and 2 cases with three spaces received anterior discectomy and cages implant. Plates were used in patients with cervical instability. Operation time and blood loss were recorded. Japanese Orthopedic Association（JOA） score system was adopted for therapeutic efficacy evaluation. JOA score were recorded preoperatively, 2 weeks, 3 months, 6 months and 12 months postoperatively. Results All cases were followed up 6 to 34 months（average 25 months）, and no serious complications were suffered. Operation time were 40-90 min（average 55 min） and blood loss were 50-250 ml （average 150 ml ）. The nervous symptoms in all 38 cases relieved significantly within 2 weeks after operation, lower limb muscle strength increased, upper limb abnormal sensation disappeared and limb moved more agile. Cervical X-ray showed intervertebral spaces height and cervical curve resumed normal. Average JOA score increased from 9.2±0.3 preoperative to 12.4±0.3 2 weeks postoperative, 13.2±0.3 3 months postoperative, 13.8±0.2 6 months postoperative and 14.2±0.2 12 months postoperative. Clinical follow-up outcome of 6 months postoperative was 12 cases of excellent, 18 cases of good, 5 cases of fair and 3 cases of poor. Conclusion Multiple level discectomy and cages implant is very effective for multiple level cervical spondylosis. It provides advantage of less blood loss, sufficient decompression, and higher fusion rate.