显微镜下颈前路经颈椎间隙减压的手术技巧

Anterior cervical decompression technique via intervertebral space under microscope

目的探讨显微镜下经椎间隙颈前路减压技术,总结手术技巧。方法 2000年6月至2005年12月间于显微镜下共行颈前路经椎间隙减压术271例,均为颈椎间盘突出患者,其中单间隙178例、双间隙71例、三间隙22例。所有患者影像显示脊髓前方压迫、压迫程度轻到中度及轻度髓内改变。主要设备为脊柱外科专用手术显微镜和高速磨钻。高速磨钻磨除纤维环和部分椎体后壁,显露清理变性髓核,钩形剥离子提起后纵韧带后切断,再切除残余的后纵韧带及椎体后缘骨赘。结果 271例手术无脊髓、神经、血管损伤并发症。手术时间(62±12.4)min,失血(126±29.4)ml,下地时间为术后(1.8±0.4)d。所有患者术后神经功能均有不同程度改善,功能改善率优69例,良157例,中27例,差18例。结论经椎间隙减压适用于椎间隙平面的病变,显微镜下精细操作及高速磨钻有利于手术成功,术后椎间隙结构更符合颈椎生物力学特性。

Objective To discuss the technique of the anterior cervical decompression via intervertebral space under microscope.Methods A total of 271 patients with cervical disc herniation underwent anterior microsurgical decompression and intervertebral fusion from Jun.2000.6 to Dec.2005.The patients included 178 cases with single level herniation,71 with double level ones,and 22 with three level ones.MRI images showed slight or medium anterior compression with slight abnormal changes within spinal cord in all cases.The main equipment included operation microscope for neurosurgery and high speed bur.The annular fibrous and osteophytes were removed by high speed bur to expose and clean the degenerative nucleus pulpous.We lifted the posterior longitudinal ligament（PLL） with tension using a hook-like stripper and cut it;then the residual PLL and posterior bony edges were removed.Results There were no severe complications such as injuries of the spinal cord,nerve root or blood vessels.The average intraoperative blood loss was（126 ±29.4） ml and the mean operative time was（62 ±12.4） min.The average time for the patients to get off bed was（1.8 ±0.4） days.The nerve functions were improved in all patients after operation,with the excellent nerve function found in 69 cases,good in 157 cases,fair in 27 cases,and poor in 18 cases according to JOA scores.Conclusion Anterior cervical decompression via intervertebral space under microscope is suitable for treatment of pathological changes of the intervertebral space;delicate manipulation under microscope and high speed bur can contribute to a successful operation;and the anatomy of intervertebral space is more suitable for the biomechanics of the cervical vertebrate.