脊髓型颈椎病手术治疗的远期疗效

Longterm Results of Surgical Treatment of Cervical Spondylotic Myelopathy

目的研究脊髓型颈椎病经手术治疗的远期疗效及影响疗效的因素。方法报告１８５例脊髓型颈椎病，对发病因素、病程及影像学表现特征进行分析。全部实施颈前路减压及自体髂骨移植融合术，其中２５例于术后６个月～２年再次手术。术后随访５年６个月～１５年，平均６年７个月。结果功能评价：优８９例（４８１％）、良５７例（３０８％）、可２８例（１５１％）及差１１例（６０％）。根据４０分评分法，平均提高８５分，其中３６～４０分７９例，３１～３６分４５例。提示病程长短与疗效相关，病程在６个月内的患者疗效优于１年以上者（Ｐ＜００１）。结论脊髓型颈椎病手术治疗远期效果是肯定的；手术时机、病理变化程度及手术技术等对治疗效果有明显影响。

Objective To observe the longterm results and its relative factors of surgical treatment of cervical spondylotic myelopathy (CSM) Methods One hundred and eightyfive cases of CSM were reviewed The pathogenesis, history and characteristics on imaging were analyzed All were treated with anterior cervical decompression and fusion with autogenous iliac bone graft Twentyfive cases had revision surgery 6 months to 2 years after the initial operation Results \ Functional evaluation revealed excellent in 89 cases (481%), good in 57 cases (308%), fair in 28 cases (151%) and poor in 11 cases (60%) According to 40 points score method, the average improvement was 85 point Of these, 79 cases were between 36 to 40 points Fortyfive cases were between 31 to 36 points It was found that the duration of illness played the main role in the final outcome Those with history of illness of less than 6 months had better results than the cases with history of more than 1 year (P< 001) Conclusions The longterm results of surgical treatment of CSM can be confirmed The timing of operation, degree of pathology and the surgical techniques are the important factors for a better outcome of the surgical treatment of CSM \