颈椎前路手术治疗脊髓型颈椎病疗效影响因素分析

Analysis of treatment effect of anterior approach surgery on cervical spondylotic myelopathy

目的探讨脊髓型颈椎病(CSM)前路手术的疗效及相关的影响因素。方法随访分析2003年8月至2008年12月笔者所在医院颈前路手术治疗的79例脊髓型颈椎病患者。MRI测量硬脊膜囊矢状径并计算膨胀恢复率,JOA法(17分)评估患者神经功能状况及术后疗效,并统计分析影响疗效的因素。结果随访6～57个月,平均27.3个月,术后改善率为优47例(59.5%),良11例(13.9),优良率为73.4%。术后改善率与病程、年龄、术前功能评分、膨胀恢复率、T2WI是否高信号有关。结论脊髓型颈椎病一旦确诊即需手术处理,颈前路减压植骨融合内固定手术疗效确切。病程、术前评分、膨胀恢复率及T2WI高信号影响手术效果。

Objective To investigate the effect of anterior approaeh surgery on cervical spondylotic myelopathy （ CSM ） and the correlation factors influencing the prognosis. Methods A retrospective review was made on the data of 79 cases with cervical spomlylotic myelopathy from Aug 2003 to Dec 2008. The sagittal diameter of dural sac of all patients were measured with MRI amt the recovery rates were calculated. The improvement of spinal cord function was assessed with the Japanese Orthopaedic Association （JOA 17） scoring system, and the effect of operation and the influential factors were analyzed. Results The mean follow - up time was 27.3 months （ from 6 months to 57 months）. The recovery was evaluated as excelent in 47 cases （59.5%） aed good in 11 cases （13.9%）, and the fineness rate was 73.4%. The improvement of spinal cord function was related with course of disease, age, preoperative JOA score, the recovery rate of the sagittal diameter of duralsac and intramedullary high signal. Conclusion Anterior cervical decompression and fusion with fixation is effective method for the treatment of cervical spondylotic myelopathy. The cases should be treated by operation while having a definite diagnosis of cervical spondylotic myelopathy. The course of disease and preoperative JOA score,the recovery of the sagittal diameter of duralsac, intramedullary high signal will be positive factors to the operation effect.