颈前路减压融合术治疗多节段颈椎病

Anterior cervical decompression with fusion on multilevel cervical myelopathy

目的报告颈前路减压融合术治疗多节段颈椎病的手术方法及临床疗效。方法回顾性分析自2003年8月-2008年1月期间,采用前路减压融合术治疗并获随访的28例多节段颈椎病患者,具体方法为间隙减压+椎体次全切除减压,取三面皮质自体髂骨或钛质网及椎间融合器(cage)填充切除病椎之松质骨置入,钢板固定。手术前后对患者进行JOA评分并计算改善率,并记录患者并发症。结果本组患者术中无并发症,随访18月～72个月。术后18月JOA评分平均改善率为75.2%,其中优11例,占39.3%;良9例,占32.1%;中8例,占28.6%;结论采用该术式的颈前路融合术治疗多节段颈椎病,减压直接彻底,恢复和重建颈椎生理曲度和病变节段椎间高度,坚强固定达到即刻稳定,疗效比较满意。

Objective To report the surgical methods and clinical effects of anterior cervical decompression with fusion on multilevel cervical myelopathy. Methods 28 cases with multilevel cervical myelopathy treated with anterior decompression and fusion were retrospective analyzed. In operation,intervertebral decompression plus corpectomy and implantation of autogeneic ilium （AI） with three faces cortical bone or titanium mesh followed by internal fixation was performed. Complications and the JOA score preoperative and postoperative were collected,then the improving rate of JOA score was calculated. Results No complications were observed in the operation. 75.2% of patients has achieved improvement of JOA score in the follow -up period ranged from 18 to 72months. The rate of excellent outcome,good outcome and moderate good outcome was 39.3%（11 cases）,32.1%（9 cases）and 28.6%（8 cases）respectively. Conclusion The technique performed decompressed directly,rebuilt the physiological cervical curvature and restored the intervertebral height of affected segments,and achieved the stability immediately after the operation. It is thus recommendable to perform anterior cervical decompression with fusion for multilevel cervical myelopathy.