全椎板减压椎弓根钉棒内固定治疗多节段颈椎管狭窄

Omni-laminectomy and transpedicular screw-rod fixation for treatment of multilevel cervical spinal stenosis

目的评价对多节段颈椎椎管狭窄症患者行后路全椎板切除、椎管减压、植骨融合并椎弓根内固定术的治疗效果。方法 2002年2月~2008年12月采用后路全椎板切除、椎管减压、植骨融合并椎弓根内固定术治疗多节段颈椎椎管狭窄患者35例,其中男20例,女15例;平均年龄为62.5岁。退变性椎管狭窄10例,发育性椎管狭窄12例,后纵韧带骨化伴椎管狭窄13例。患者颈椎椎管狭窄的节段均≥3个。术前日本骨科学会（Japanese Orthopaedics Association,JOA）评分为6.7±1.2分。结果手术时间平均为135 min。所有患者均获随访,随访时间为3~36个月,平均12.5个月,随访期间未发现严重的手术并发症发生。术后1周JOA评分为8.2±1.5分,与术前相比差异有统计学意义（P〈0.05）,术后6个月JOA评分为12.8±1.8分,与术后1周相比差异有统计学意义（P〈0.05）。结论椎管减压、植骨融合并椎弓根内固定术是治疗多节段颈椎椎管狭窄行之有效的方法,既解决了减压不彻底的问题,又保证了颈椎的稳定性;但颈椎椎弓根螺钉技术需要术者扎实的局部解剖知识以及丰富的置钉经验。

Objective To evaluated the therapeutic efficacy of posterior omni-laminectomy,spinal canal decompression,bone grafting fusion and transpedicular screw-rod fixation for the treatment of cervical spinal canal stenosis.Methods From February 2002 to December 2008,35 patients（20 males and 15 females,with a mean age of 62.5 years） with cervical spinal stenosis were treated by posterior omni-laminectomy,spinal canal decompression,bone grafting fusion and transpedicular screw-rod fixation.In all patients,10 cases were degenerative spinal stenosis,12 cases were developmental spinal stenosis and 13 cases were ossification of posterior longitudinal ligament combined with spinal stenosis.Segments of each patient were no less than 3.Preoperative Japanese Orthopaedics Association（JOA） scores were 6.7±1.2.Results The average time of operation was 135 min.All patients were followed up for 3-36 months（mean 12 months） and no complication occurred during the follow-up.JOA scores of 1 week after operation were 8.2±1.5,compared with pre-operation the difference was statistically significant（P0.05）;JOA scores of 6 months after operation were 12.8±1.8,compared with 1 week postoperative the difference was statistically significant（P0.05）.Conclusion Treatment of cervical spinal canal stenosis by posterior omni-laminectomy,spinal canal decompression,bone grafting fusion and transpedicular screw-rod fixation is an effective method,which can get thorough decompression and good cervical spinal stability.But the application of transpedicular screw-rod internal fixation technique in cervical vertebae demands a well-knit knowledge in cervical spinal anatomy and affluent experiences in cervical spinal transpedicular screw-nod insertion.