多节段颈椎病前路选择性手术的评价

Evaluation of selective anterior surgical treatment for multisegmental cervical spondylosis

目的：分析不同颈前路手术对多节段颈椎病的治疗效果。方法：选择４７例患者手术前后情况进行回顾。第１组７例为单一平面颈前路椎间盘切除植骨融合术患者，第２组２６例为多平面颈前路椎间盘切除植骨融合术患者，第３组１４例为颈椎次全椎体切除术患者。采用日本矫形外科学会（ＪＯＡ）评分标准评价术后随访结果。结果：第２、３组手术效果好于第１组，但并发症发生率也较第１组高。第２、３组间手术效果无显著差别，第３组术后并发症发生率最高。结论：对于多节段颈椎病，多平面颈前路减压植骨融合结合颈椎次全椎体切除术是一种直接有效的手术，而次全椎体切除术更适用于伴有颈椎后纵韧带骨化患者。

Objective: To analyze the efficacy in the treatment patients with multisegmental cervical spondylosis by different anterior cervical surgical strategy. Methods: A retrospective review of 47 patients who had undergone anterior cervical decompression and fusion was performed. Group Ⅰ consisted of 7 consecutive patients treated with singlelevel anterior cervical discectomy and autograft fusion. Group Ⅱ consisted of 26 consecutive patients treated with multilevel anterior cervical discectomy and autograft fusion. Group Ⅲ consisted of 14 consecutive patients treated with subtotal vertebrectomy and fusion. The Japanese Orthopaedic Association (JOA) classification was used to assess the followup results. Results: The operative results of Group Ⅱ and Group Ⅲ were better than that of Group Ⅰ. There were not significant differences between effects of Group Ⅱ and Group Ⅲ, although the overall operative complication rate of Group Ⅲ was the highest, whereas that of Group Ⅰ was the lowest. Conclusion: Multilevel anterior cervical decompression and fusion by a combination of subtotal vertebrectomy for multisegmental cervical spondylosis are a straightforward procedure. The subtotal vertebrectomy is more proper for multisegmental cervical spondylosis with ossification of the posterior longitudinal ligament.