一期颈椎后路单开门联合前路选择性融合治疗重度脊髓型颈椎病

One-stage posterior open-door laminoplasty combined with anterior selective vertebral fusion for severe cervical spondylotic myelopathy

目的探讨一期颈椎后路单开门联合前路选择性融合治疗重度脊髓型颈椎病的疗效。方法2005年6月～2008年12月,对66例重度脊髓型颈椎病患者进行了一期颈椎后路单开门联合前路1～2个节段选择性融合手术治疗。其中男53例,女13例;年龄39～62岁,平均51.9岁。前方融合1个椎间隙49例,融合2个椎间隙17例;后方C3～6开门18例,C3～7开门48例。比较手术前后JOA评分及颈椎生理曲度(中立位C2～C7前凸角)。结果所有患者安全接受手术,无不可逆性神经损伤,无融合失败等严重并发症发生。手术时间3.5～5.0 h,平均4.4 h。术中出血量300～1100ml,平均590ml。所有患者都得到1年以上随访,平均随访时间19个月(12～41个月)。术前JOA评分7～12分,平均9.5分;术后1年随访JOA评分9～16分,平均13.9分,二者比较有统计学差异(P<0.05),改善率为46%;中立位C2～C7前凸角术前为2°～13°,平均8.9°;术后1年随访为12°～21°,平均16.7°;二者相比有统计学差异(P<0.05)。结论一期颈椎后路单开门联合前路选择性融合治疗重度脊髓型颈椎病手术安全,能获得良好的减压效果,改善颈椎生理曲度。

Objective To evaluate the effectiveness of one-stage posterior open-door laminoplasty combined with anterior selective vertebral fusion for severe cervical spondylotic myelopathy. Methods From June 2005 to December 2008, 66 patients with severe cervical spondylotic myelopathy were underwent one-stage posterior open- door laminoplasty combined with 1-2 levels anterior selective vertebral fusion. 53 male and 13 female aged from39 to 62 （51.9 in average） were involved. 49 patients underwent anterior 1 level fusion while 17 underwent anterior 2 levels fusion. The range of posterior laminoplasty was C3 to C6 in 18 cases and C3 to C7 in 48 cases. The JOA score and alignment of the cervical spine （angle of C2-7 in neutral position） were analyzed pre- and post-operatively respectively. Results All the patients underwent the operation, and none of them developed severe complication of irreversible neurological injury or fusion failure. The average surgery time was 4.4 h （3.5h to 5.0h）. The average blood loss during the operation was 590ml （300 to 1100ml）. The average time of follow-up was 19m （12-41 m）. The average pre-operative JOA score was 9.5 （7 to 12） while the post-operative JOA score was 13.9 （9 to 16）. The difference was significant （P〈0.05）, and the improvement rate was 46%. There was also significant difference in angle of C2-7 （P〈0.05）, which was 8.9° in average, （from 2 to13°） pre-opcrativcly and 16.7° inaverage （froml2 to 21°）.post-operatively. Conclusions One-stage posterior open-door laminoplasty combined with anterior selective vertebral fusion is an effective treatment for severe cervical spondylotic myelopathy. It can achieve good decompression and better cervical spine alignment.