颈前路保留中部椎体的分段减压治疗多节段颈椎病

Segmental Anterior Cervical Decompression with Reservation of Middle Vertebrae for Treatment of Multiple Level Cervical Myelopathy

目的通过比较,评价颈椎前路分段减压、保留中部椎体、钛网植骨长钛板内固定治疗多节段颈椎病的疗效和应用价值。方法采用颈前路长节段减压治疗多节段颈椎病21例,分段减压治疗32例。根据影像学检查评估术后内固定的并发症、植骨融合率、颈椎生理曲度的恢复和重建,根据JOA评分评估神经功能改善率。结果长节段减压组有4例出现内固定并发症,主要为钛网和螺钉的松动脱落;分段减压组未出现并发症。术后6个月长节段减压组有4例钛网植骨未达到骨性融合,分段减压组均达到融合。术前与术后比较Cobb角的改善,分段减压组明显优于长节段减压组(P<0.05)。JOA评分两组无明显差别(P>0.05)。结论采用颈前路保留中部椎体分段减压、钛网植骨长钛板固定、术后外固定保护治疗多节段颈椎病,可有效地进行颈前路融合、改善颈椎生理曲度,促进神经功能恢复。

Objective To compare the outcomes of two operative methods, discuss the segmental anterior cervical decompress with reservation of the middle vertebrae for treatment of multiple level cervical myelopathy. Methods Data of multiple level CSM undergoing the segmental anterior cervical decompression with reservation of the middle vertebrae （32 patients） and the anterior decompression in one segment （21 patients） were retrospectively analyzed. The incidence of perioperative complications and the rate of fusion were evaluated by the postoperative X - ray and MRI examinations. The improvement of the neurological function was evaluated by the JOA score. Resuits The incidence of internal fixation complications was 19 % in the one segment group, mainly including titanium mesh loosening and plate breaking. The internal fixation complications were 0% in the segmental cervical decompression. The fusion of bone graft was 80.9 % in the one segment group 6 months postoperative. The complete fusion of bone graft was observed in the segmental cervical decompression. There was significant difference in Cobb angle improvement between segmental cervical decompression and one segment group （P 〈 0.05）. According to the JOA score, there was no significant difference between the two groups （P 〉 0.05）. Conclusion Segmental anterior cervical decompression with reservation of the middle vertebrae for treatment of multiple level cervical myelopathy can prevent nonunion after decompression of cervical spine and maintenance of physiologic curves and improve neurological function.