脊髓型颈椎病Ⅰ期前后联合入路手术治疗的选择策略

The choice strategy for treatment of cervical spondylotic myelopathy by one-stage anterior-posterior decompression and stabilization

目的探讨脊髓型颈椎病Ⅰ期前后联合入路手术治疗的选择策略。方法对22例脊髓型颈椎病采用I期前后联合入路手术治疗,记录其手术时间、术中出血量及术后并发症,并进行随访,采用JOA评分法对其临床疗效进行评估。结果所有患者均获得为期10-20个月（平均13个月）随访,手术时间200-350min,平均240min.术中出血400-1 200ml,平均600ml,JOA评分术后改善优13例;良4例;中1例;差3例。结论Ⅰ期前后联合路手术是脊髓型颈椎病的有效治疗方法,但需严格手术适应证,只有影像学上具有钳夹样表现和（或）严重脊髓受压的脊髓型颈椎病病例可考虑行I期前后联合入路,对于其他情况的脊髓型颈椎病需慎重选择I期前后联合入路手术。

Objective To explore the choice strategy for treatment of cervical spondylotic myelopathy（CSM） by one-stage anterior-posterior decompression and stabilization.Methods Twenty-two patients with CSM who underwent posterior laminoplasty with the combination of anterior decompression and internal fixation in one stage were followed up,and the surgical time,blood loss and complication,and the clinical effects were evaluated by the Japanese Orthopedic Association（JOA） scoring system.Results All patients were followed up from 10 to 20 months on the average of 13 months.The surgical time was 240 min（200-350 min） and blood loss was 600 mL（400-1 200 mL）.The JOA scores were increased： excellent in 13 cases,good in 4 cases,moderate in 1 case and poor in 3 cases.Conclusion One-stage anterior-posterior decompression and stabilization is effective in the treatment of CSM.Regarding the operative trauma is relatively serious,it＇s necessary to discreetly consider its indications.Only CSM with changes of pinching or severe spinal cord compression by imaging studies could be given single-stage anterior-posterior decompression and stabilization.