一期前后路联合手术治疗复杂脊髓型颈椎病近期疗效观察

The observation of one stage combined anterior-posterior decompression for severe cervical spondylotic myelopathy

目的:观察一期前后路联合手术治疗复杂脊髓型颈椎病的疗效,并探讨其手术适应证。方法:采用一期前后路联合减压术对12例前后均受压的脊髓型颈椎病患者进行治疗。随访患者临床和影像学情况,按JOA评分标准评定神经功能,评价临床疗效。结果:手术2.5～5h,术中出血量480～1200ml,术中出现脑脊液漏2例。随访6个月至4年,前路植骨及后路门轴全部骨性愈合。神经功能改善率均为优;MR I复查显示硬膜囊明显后移、前后方压迫解除、脑脊液通畅,CT显示椎管扩大充分,开门度数平均为45.2°。结论:对于前后均受压的脊髓型颈椎病且前方压迫较重时,一期前后路联合减压手术可取得较好的近期疗效。

Objective：To investigate the clinical outcome and indication of one stage combined anterior-posterior decompression for severe cervical spondylotic myelopathy（CSM）.Methods：Retrospective analysis of 12 cases with severe CSM were performed one stage combined anterior-posterior decompression.Japanese Orthopedic Association（JOA） score system and the clinical outcome were used to evaluate the neural function.The improvement rate and clinical curative effect were evaluated.Results：The surgical time was 2.5-5 hours,blood loss was 480-1 200 ml.No severe intraoperative complication was noted except cerebrospinal fluid leakage in 2 cases.All cases were followed up from 6 months to 4 years,both anterior grafts and posterior door axial had bony union.All cases had excellent neural function improve rate.MRI showed dural cyst moved dorsally and decompression in all cases,CT showed the spinal canal was enlarged sufficiently and the average angle of open-door was 45.2°.Conclusions：When patients with complex multi segmental CSM are carefully selected and surgery is indicated,the one-stage combined anterior-posterior decompression approach can achieve good short-term clinical effect.