前路减压植骨钢板内固定治疗脊髓型颈椎病(32例报告)

Anterior cervical decompression and autograft fusion with plate fixation for treating spondylotic cervical myelopathy(report of 32 cases)

[目的]分析经前路减压椎间植骨融合结合钢板内固定治疗脊髓型颈椎病的临床疗效。[方法]2002年2月～2008年4月,本院对32例脊髓型颈椎病患者行颈前路减压椎间植骨融合钢板内固定术。术后对临床结果进行JOA评分;观察并发症情况;1、2、3、6、9、12个月摄片,观察植骨融合效果。[结果]32例获得6～24个月(平均15个月)的随访。JOA评分,术后症状明显缓解和消失,由术前7～10分(平均8.6分)恢复至术后12～14分(平均12.8分);平均植骨融合时间12周,植骨融合率100%;1例术后3h颈部血肿形成,切开引流后,症状缓解;1例术后1个月螺钉松动,延长颈围外固定时间至术后6个月,固定节段融合。[结论]颈前路减压椎间植骨融合结合钢板内固定治疗脊髓型颈椎病疗效确切,可以有效解除脊髓前方所受的压迫;显著提高植骨融合率,临床疗效满意。

[ Objective ] To evaluate the clinical effect of anterior cervical decompression and autograft fusion with plate fixation on spondylotic cervical myelopathy. [ Methods] From February 2002 to April 2008, 32 cases of spondylotic cervical myelopathy were treated with anterior cervical decompression and autograft fusion with plate fixation. During the follow - up, the effect of fusion was observed for 12 months, complications were observed , and the results were evaluated by JOA. [ Results] Thirty- two patients were followed up for 6 - 24months （15 months on average） . Symptoms after operation were apparently found or cured. The JOA grade raised from 7 - 10 before operation （ average 8. 6） to 12 - 14 （average 12. 8） after treatment. The mean time for interbody fusion were 12 weeks, and its effective rate was 100 %. Cervical hematoma was found 3 hours postoperatively in 1 case, and symptom was relived after drainage treatment. Screw loosening was found after operation in another case, solid fusion of the fixation segment was achieved after external fixation for 6 months. [ Conclusion] Spondylotic cervical myelopathy patients can be treated through the surgical method with anterior cervical decompression and autograft fusion with plate fixation. The method can release the anterior pressure on the spinal cord, and significantly increase the rate of interbody fusion.