保留终板软骨下骨的颈椎后纵韧带悬吊切除技术

The technique of posterior ligament pulling resection in Smith-Robison intervertebral fusion for treatment cervical spondysis

目的介绍既保留终板软骨下骨又可直接减压的后纵韧带悬吊切除技术。为颈椎人工椎间盘置换、前路椎间融合提供技术前提。方法91例（91椎间隙），男71例，女20例；年龄31-71岁，平均49．8岁；病程1d-25个月，平均10个月。破碎椎间盘35例，椎间盘突出39例，后纵韧带不完全骨化17例。C2.3 1例，C3.4 19例，C4.5 33例，C5．6 34例，C6．7 4例。颈椎脊髓病57例，颈椎神经根病5例，退变合并无骨折脱位脊髓损伤29例。术前JOA颈脊髓功能评分为（6．47±1．33）分。采用悬吊法切除后纵韧带操作分为五步，第一步切开椎间盘、第二步扩大椎间隙、第三步显露后纵韧带、第四步悬吊切断后纵韧带、第五步探查椎管。结果手术时间平均1．7h，平均出血量33ml。平均随访16．5个月（8～22个月），术后JOA评分为（13．71±1．94）分，和术前比较差异有统计学意义（t=19．72，P〈0．01），疗效优良率98．9％。除5例硬膜轻度撕裂外无与韧带切除相关的其他并发症。X线显示椎间隙平均融合时间3．5个月（2．5-5．5个月）。结论在保留终板软骨下骨的同时通过悬吊法切除后纵韧带是相对安全的手术方法。

Objective To introduce posterior ligament pulling resection technique and to discuss it＇s benefits for cervical anterior decompression and cervical disc arthroplasty. Methods Ninety-one patients （91 discs） were resected, including 71 males and 20 females with the average age of 49.8 years （range 31-71 years）. The present history rang from 1 day to 25 months （average 10 months）. Herniation or sequestra discs in 35 cases, protrusion in 39 cases, incomplete ossification longitudinal ligament in 17 cases. Once the IMSOP Standard Neurological Classification of SCI and radiographic diagnosis were corresponded the localization of responsible disc was established. The lesions localized at C2.3 for 1 case,C3.4 for 19 cases,C4.5 for 33 cases,C5.6 for 34 cases,C6.7 for 3 cases. Present as cervical myelopathy in 57 cases, as cervical radiculopathy in 5 cases, as degeneration combined with spinal cord injury without radiographic abnormalities in 29 cases. The JOA cervical spinal cord function standard （17 scores） was applied to evaluate the treatment. Pre-operative JOA score was 6.47±1.33. Five steps decompression were performed： 1st open disc, 2nd enlargement space, 3rd expose the ligament, 4th hang resection, 5th explore the spine canal. Results The mean operation time was 1.7 hours, average bleeding amount was 33 ml. The mean follow-up period was 16.5 months （range 8-22 months）. Postoperative JOA score was 13.71±1.94, comparing with the preoperative score, the difference was significant （t=19.72, P〈 0.01）. Beside dura mild laceration in 5 cases, there was no other complications. The X-ray pictures showed that the average bone union time was 3.5 months （range 2.5-5.5 months）. Conclusion Posterior ligament hook pull resection technique is a comparative safety and effective technique to decompress cervical spinal cord anteriorly.