一期前后联合入路治疗重度脊髓型颈椎病的疗效分析

One-Stage Posterior-Anterior Approach Surgical Treatment for Severe Cervical Spondylotic Myelopathy

目的探讨前后路联合手术治疗脊髓型颈椎病(CSM)的临床效果。方法回顾性分析2006年9月—2009年2月本院采用一期前后路联合手术治疗42例重度CSM患者,男32例,女10例;年龄41～76岁,平均58.5岁。前路减压涉及1个椎间隙者8例,2个椎间隙者28例,涉及3个椎间隙及以上者6例。本组患者均采用一期颈后路单开门椎管扩大成形和前路间盘摘除减压植骨内固定术。依据日本骨科学会脊髓功能17分法(JOA 17)标准,观察并记录患者的神经功能恢复情况,比较术前、术后3个月及末次随访时的JOA 17评分,评价临床治疗效果。结果手术时间为2.5～4.0 h,平均3 h。术中出血200～800 ml,平均400 ml,无严重手术并发症。所有患者定期随访,随访6～21个月(平均18.2个月),前路植骨及后路门轴全部骨性愈合,术前患者JOA 17评分为(6.42±1.22)分,术后3个月为(12.24±0.55)分,末次随访为(13.17±0.68)分,术前、术后3个月及末次随访时JOA 17评分间差异有统计学意义(F=748.37,P<0.05);前后路联合手术改善率为(72.31±5.33)%。结论对前后受压的重度CSM采用前后路联合一期手术治疗,可使椎管充分减压的同时颈椎获得可靠的稳定性,为脊髓功能恢复创造有利条件,可明显提高CSM临床改善率,减少并发症的发生。

Objective To explore the therapeutic effects of anterior-posterior approach surgical treatment for multi-level cervical spondylotic myelopathy（CSM）.Methods Totally 42 patients（32 males and 10 females,aged 41～76,with an average age of 58.5） with severe cervical spondylotic myelopathy underwent one-stage posterior-anterior approach surgical treatment from September 2006 to February 2009 were retrospectively analyzed.Of the 42 patients,8 were with lesions involving one intervenebral space,28 were with lesions involving two intervenebral spaces and 6 were with lesions involving three intervertebral spaces.All cases underwent posterior cervical open-door laminoplasty decompression and subsequent anterior cervical decompression and bone grafting or fusion with titanium cage internal fixation after a week.Neural function was recorded according to JOA score.JOA scores before operation,three months after operation,at the last follow-up were compared to evaluate the curative effects.Results Operation time ranged from 2.5 to 4.0 hours（averaged 3 hours）.Intraoperative bleeding was 200～800 ml（averaged 400 ml）.No severe complications were observed.All cases were regularly followed-up.The duration of followed-up averaged 18.2 months（ranged 12～21 months）.JOA score before operation was（6.42±1.22）,JOA score 3 months after operation was（12.24±0.55）,JOA score at the last follow-up was（13.17±0.68）（F=748.37,P0.05）;the improvement rate of posterior-anterior approach in treating severe cervical spondylotic myelopathy was（72.31±5.33）%.Conclusion The application of posterior-anterior approach in treating complicated severe cervical spondylotic myelopathy is able to raise the clinical improvement rate and reduce the occurrence of complications with reduced canal pressure and reliable cervical stability obtained.