颈椎前入路手术治疗脊髓型颈椎病的疗效分析

Analysis on Curative Effect of Anterior Cervical Approach Surgery in the Treatment of Cervical Spondylotic Myelopathy

目的:探讨经颈椎前入路手术治疗脊髓型颈椎病的方法,并分析其临床疗效。方法:40例脊髓型颈椎病患者分为A组20例、B组20例,分别于体感诱发电位监测下施行颈椎前入路椎间盘切除、椎体次全切除并椎体间cage(A组)和钛网(B组)植入融合、前路钢板内固定术。根据日本整形外科协会(JOA)评分及影像学改善程度,评价手术疗效。结果:40例患者手术后临床症状均明显改善,无1例发生出血、瘫痪、脑脊液漏、食管瘘及内固定松脱、断裂等严重并发症。术后2组病例JOA评分均有改善,A组术后3d及1个月JOA评分分别为(13.76±0.74)分和(14.67±0.64)分、B组术后3d及1个月JOA评分分别为(14.36±0.75)分和(14.74±0.67)分,均较术前A组(7.95±0.82)分、B组(8.35±0.61)分明显增加,差异有统计学意义(P<0.01)。影像学显示2组病例均减压充分,椎体间融合良好,内固定位置准确。结论:经颈椎前入路施行椎间盘切除、椎体次全切除并椎体间融合、前路钢板内固定术治疗脊髓型颈椎病,安全性好,成功率高,疗效满意。

Objective：To evaluate the surgical treatment of cervical anterior approach for cervical spondylotic myelopathy（CSM）,and to analyze its clinical efficacy.Methods：Forty cases of CSM were divided into group A（20 cases） and group B（20 cases）.Under the monitoring of somatosensory evoked potential,anterior cervical discectomy or vertebral body subtotal excision were performed in the patients.Cage or titanium mesh transplantation was performed in group A or group B,respectively.The therapeutic effect was evaluated according to Japanese Orthopedic Association（JOA） score and imaging.Results：After operation,clinical features of 40 patients were improved obviously.There were no any serious complications.At the 3rd d and the 1st month after operation,the JOA scores of group A were（13.76±0.74） and（14.67±0.64）,and group B were（14.36±0.75） and（14.74±0.67）,respectively,which were significantly higher than that before operation（（7.95±0.82）;（8.35±0.61）,P0.01）.Radiological studies revealed that the spinal cord was decompressed completely,and the interbody fusion and internal fixation were all in satisfactory position.Conclusion：The anteriorcervical diskectomy,subtotal cervical corpectomy,interbody fusion and anterior internal fixation for the treatment of cervical spondylotic myelopathy is safe and effective.