前路减压植骨融合治疗脊髓型颈椎病

The Results of Surgical Treatment of Cervical Spondylotic Myelopathy with Anterior Decompression and Fusion with Autograft and Plating

目的评价前路减压植骨融合治疗脊髓型颈椎病的临床效果。方法本组40例患者，男性22例，女性18例；年龄37～68岁，平均53岁。病程3个月～9年，平均13个月。术前检查包括颈椎正侧位、过屈过伸位X线片和MRI检查。手术前后进行JOA评分。16例单节段椎间隙病变者行环锯减压，22例双节段椎间隙病变者和2例三节段椎间隙病变者行椎体次全切除，所有病例行髂骨植骨融合加Zephir钛板固定。结果36例获得随访，平均随访6年1个月（4年10个月～7年9个月）。手术有效率为91．7％（33／36），手术优良率为77．8％〈28／36）。术前JOA评分4～13分，平均为7．9分，术后末次JOA评分6～16分，平均为13．5分。神经功能平均改善率为76．3％。36例术后X线片示植骨在术后12～18周获得骨性融合，植骨融合率100％，术后颈椎间隙高度和生理曲度维持良好，内植物位置良好，无钛板和螺钉松动或断裂现象。并发症5例：取骨区局部疼痛3例，术后3个月消失；股前外侧麻木1例，术后1个月恢复；脑脊液漏并感染1例。结论加强围手术期的管理，预防并发症的发生和积极处理并发症是非常重要的，前路减压植骨融合治疗脊髓型颈椎病可取得优良的临床效果。

Objective To determine the clinical outcomes ot the surgical treatment of cervlcal sponclylotic myelopathy （CSM）with anterior cervical discectomy and fusion（ACDF）with autograft and plating. Methods 40 patients（male 22 patients,female 18 patients）with cervical spondylosis who had surgical treatment were analyzed. The average age was 53 years（range ,37-68 years）and average period between myelopathie symptoms and surgery was 13 months （range, 3- 108 months）. Preoperative evaluation of every patient consisted of anterior-posterior,lateral, flexion ,extension radiographs and magnetic resonance imaging of the cervical spine. Degree of pre-and postoperative cervical spondylosis was determined according to the scoring systems developed by Japanese Orthopedic Association （JOA）. In 16 patients who had one-level Cloward＇s decompression,in 22 patients who had 2-level corpectomy and in 2 patients who had 3-level corpectomy. All of 40 patients had iliac autograft and plate fixation after corpectomy. Results 36patients were followed-up. The average period of follow-up was 73 months （range, 58 to 93 months）. The effec tive rate was 91.7% ,the excellent and perfect rate was 77.8%. Average preoperative and postoperative JOA score were 7.9（range 4-13）and 13.5（range 6-16）. The improving rate of nerve function was 76.3%. The rate of fusion in 36 patients was 100%in the 12-16 weeks interval postoperatively. The normal cervical alignment was maintained. No graft complication such as collapse ,subsidence ,extrusion and nonunion occured ,no complication related to implant occured. The donor-site pain disappeared in 3 months postoperatively in 3patients,the numb of anterior thigh recovered in a month in 1 patient,infection and epidural laceration in 1 patient. Conclusion During perioperative period,it was important to prevent and treat the complications. The clinical outcomes of the surgical treatment of CSM with ACDF with autograft and plating were excellent or perfect.