前路选择性椎体切除分节段减压植骨融合术治疗多节段脊髓型颈椎病的疗效分析

Clinical outcomes of selective anterior corpectomy combined with segmental discectomy and fusion for multilevel cervical myelopathy

目的回顾性分析前路选择性椎体次全切除分节段减压植骨融合术治疗多节段脊髓型颈椎病的疗效。方法 32例多节段脊髓型颈椎病患者均接受前路选择性椎体切除分节段减压植骨融合术,平均年龄为63.4岁。测量术后颈椎矢状面的活动度;采用日本骨科学会(Japanese Orthopaedic Association,JOA)评分评估功能恢复情况;采用正侧位、动力位X线片评估融合程度。结果所有病例均获得平均25.2个月的有效随访。JOA评分术前为8.3±1.6,术后6个月为12.5±1.6,末次随访时为12.6±1.6,与术前比较差异均有统计学意义(P<0.05)。末次随访时除1例出现假关节外,其余病例均已达到骨性融合。术前活动度为68.3°±5.8°,术后6个月为43.9°±4.2°,末次随访时为45.9°±4.5°,与术前比较差异均有统计学意义(P<0.05)。结论前路选择性椎体切除分节段减压植骨融合术因保留中间椎体,并结合应用多组螺钉固定钢板,避免了因为跨多节段植骨内固定而导致的内置物失败。

Objective To retrospectively analyze the outcomes of selective anterior subtotal corpectomy combined with segmental discectomy and fhsion tot muhilevel cervical spondylotic myelopathy （MCSM）. Methods A total of 32 patients with MCSM were treated with selective anterior subtotal coq）ectomy combined with segmental discectomy and fusion. The average age of these patients were 63.4 years. The range of motion （ROM） of sagittal cervical spine was measured ＂after the surgery. Functional recovery was evaluated by Japanese Orthopedic Association （JOA） score. Postoperalive anteroposterior, lateral and dynamic X-rays were used to access fusion rate. Results All the patients were followed up for 25.2 months on average. JOA scores were improved from 8.3± 1.6 preoperatively to 12.5 ± 1.6 （ P 〈 0.05 ） 6 months postoperatively and 12.6±1.6 （ P 〈 0. 05） at the final follow-up. Bone fusion was aehieved in everyone except 1 case with pseudarthrosis at the final follow-up. ROM was decreased from 68.3° ± 5.8° preoperatively to 43.9° ±4.2° （ P 〈 0.05 ） 6 months postoperatively and 45.9° ±4.5°（P 〈0.05） at the final follow-up. Conclusion For multilevel cervical myelopathy, selective anterior corpectomy combined with segmental discectomy and fusion can retain the intermediate vertebrae and avoid the implant failure of muhilevel internal fixation.