一期前后路手术C7棘突骨椎间植骨融合治疗脊髓型颈椎病

One-stage anterior and posterior decompression and interbody fusion using C7 spinous process for cervical spondylotic myelopathy

目的:总结前后路一期手术时应用自体C7棘突骨行椎间植骨融合治疗脊髓型颈椎病(CSM)的临床疗效。方法:2004年2月至2008年12月,对30例脊髓前后方均有压迫的CSM患者采用一期前后路手术,其中男21例,女9例,年龄39～70岁,平均54.5岁;术前JOA评分4～13分,平均7.6±2.5分。后路手术时切取C7棘突骨作为前路椎间植骨融合的材料。观察患者术后神经功能改善和椎间植骨融合情况。结果:手术时间3.0～5.0h,平均3.5h;术中出血量270～600ml,平均380ml。未发生脊髓神经症状加重、感染、脑脊液漏等并发症。随访6～50个月,平均24.2个月,末次随访时JOA评分9～15分,平均13.7±1.8分,平均改善率为72%,其中优7例,良18例,好转5例。椎间植骨全部获得融合,未见植骨块塌陷和移位,内固定无松动和断裂。结论:对脊髓前后方均有压迫的CSM患者采用一期前后路手术减压可取得良好的效果,将后路手术时切取的自体C7棘突骨用于前路椎间植骨具有取骨简便、融合率高及相对节省治疗费用的优点。

Objective：To investigate the clinical effect of one-stage anterior and posterior decompression and interbody fusion using C7 spinous process for cervical spondylotic myelopathy（CSM）.Method：From February 2004 to December 2008,30 patients with spinal cord compression both ventrally and dorsally underwent onestage anterior and posterior decompression surgery.There were 21 males and 9 females with the average age of 54.5 years（range,39-70 years）.The average JOA score was 7.6±2.5（range,4 to 13） preoperatively.The spinous process of C7 harvested in posterior approach was used as graft material in anterior approach.All cases were followed up to investigate the interbody fusion status,neurological function and complications.Result：The mean operative time was 3.5 hours（range,3.0-5.0 hours）,the mean blood loss was 380ml（range,270-600ml）.There were no severe complications such as skin incision infection,internal fixation failure,cerebrospinal fluid leakage and deteriorated neurological function.The mean follow-up period was 24.2 months（range,6-50 months）.Satisfactory outcome was obtained postoperatively.The average JOA score was 13.7 ±1.8 at final follow up（range,9-15）.The average recovery rate of neurological function was 72% at the final follow-up,which showed excellent in 7 cases,good in 18 cases,improved in 5 cases and no poor.All 30 segments got bony fusion with no graft subsidence.Conclusion：One-stage anterior and posterior decompression and interbody fusion using C7 spinous process for cervical spondylotic myelopathy is reliable,which has high fusion rate as well as shortening operation time and lowering cost.