经颈前入路显微外科手术治疗老年颈椎病

Anterior microsurgery for cervical spondylosis in elderly patients

目的 介绍并讨论前路显微外科手术治疗老年颈椎病。方法 对 6 0例病人实施了颈间盘、后纵韧带及椎体后缘骨赘显微手术切除椎体融合术 ,对 2 4例病人实施了椎体切除显微手术减压椎体融合钛板固定术。结果 6 6例 (79% )术后症状改善 ,14例 (17% )无变化 ,2例 (2 % )症状加重 ,2例 (2 % )死亡 (1例死于冠心病 ,1例死于肺栓塞 )。统计学分析表明 ,病人手术前后神经功能状况的差异有显著性 ,术后明显优于术前 (P <0 0 0 0 1)。病人术前神经功能Ⅱ级术后恢复到Ⅰ级者占 78% ,而术前Ⅲ级和Ⅳ级术后恢复到Ⅰ级者分别只占 43%和 35 % ,其差异有显著性 (χ2 =9 2 891,P =0 0 0 2 3)。病人年龄和ASA级别均与术后神经功能状况无相关关系 (P >0 337,P >0 2 2 7)。病人年龄和术前神经功能状况与术后非手术并发症发生率无相关关系 (P>0 399,P>0 0 74)。结论 颈前入路显微外科手术治疗老年颈椎病 ,包括症状严重的病人 ,方法安全可行 。

Objective To introduce and explore the anterior microsurgery for cervical spondylosis in elderly patients. Methods In 60 patients microsurgical resection of the involved cervical disc and posterior osteophytes was performed followed by anterior fusion. Spondylectomy, microsurgical decompression and osteosynthesis was performed in 24 patients with multilevel cervical stenosis. Results 66 patients(79%) were improved, 14 patients(17%) were unchanged, two patients(2%) became worse and two patients(2%) died postoperativelly. Postoperative recovery was statistical significantly correlated to the pre operative neurological status (P<0.0001). 78% Patients with pre operative neurological grade Ⅱ were improved to grade I, but only 43% and 35% patients in grade Ⅲ and Ⅳ were improved to grade I respectively, the statistical difference is significant (X 2=9 2891,P=0 0023). Neither age, nor the pre operative ASA grade had a significent in fluence on the postoperative outcome(P>0 337,P>0 227). Neither age, nor the pre operative neuological status of the patients had a significent in fluence on the in cidence of non surgical complications(P>0 399,P>0 074). Conclusions Anterior microsurgery of cervical spondylosis, even in severe cases, can be performed safety and effectively, for elderly patients, resulting in a significant relief of pre operative clinical symptoms and signs in the majority of patients.