脊髓型颈椎病的再认识

Further recognition of cervical spondylotic myelopathy

目的：通过大量临床病例观察，对脊髓型颈椎病发病因素、临床表现及其诊断作深入认识。方法：回顾性分析１５５例手术处理的脊髓型颈椎病病例的临床资料。根据功能恢复状态评价手术疗效。结果：１２５例获得随访，平均随访２年６个月。优良者１０５例（占８５％）。脊髓型颈椎病发病与颈椎解剖结构动态和静态因素相关，动态变化是最主要的因素。脊髓型颈椎病的自然史、脊髓损害程度决定了临床表现。早期症状和体征的发现为早期诊断提供了依据。结论：手术治疗时机的选择是提高疗效的重要手段。

Objective:To understand the pathogenesis, clinical characteristics and diagnosis of cervical spondylotic myelopathy (CSM) more deeply through observation of a large number of clinical cases. Methods: The clinical data from 155 cases of CSM treated operatively were retrospectively analysed, and the therapeutic efficacy was evaluated according to their functional recovery. Results: One hundred and twentyfive cases were followed up for 2 years and 6 months on average. Of them, 105 cases were excellent or good (84%). The pathogenesis of CSM was related to dynamic and static anatomy structural factors. Especially dynamic changes were the most important factors. The clinical characteristics were decided by the natural history and grade of spinal cord injury. Early findings of symptoms and signs were the basis of early diagnosis. Conclusion: The selecting of surgery is very important to improve the treatment outcomes.