颈前路椎体次全切除联合椎间隙减压融合内固定术治疗多节段颈椎病

Subtotal vertebrectomy combined with anterior decompression through cervical disc space and fusion for multilevel cervical spondylosis

目的：探讨颈前路椎体次全切除联合椎间隙减压融合内固定术治疗多节段颈椎病的疗效。方法：回顾性分析2002年3月～2012年1月采用颈前路椎体次全切除联合椎间隙减压融合内固定术治疗的32例多节段颈椎病患者资料，男20例．女12例：年龄48～76岁，平均52．32±5．73岁。脊髓型颈椎病26例，脊髓型合并神经根型颈椎病6例。病变累及3个节段29例，累及4个节段3例。术前JOA评分为8．07±1．82（5~11）分，颈前柱高度为67．29＋2．63（61．98．73．01）mm，颈椎曲度C值为2．86±2．63[（一3．14）～8．42]。均行颈前路混合减压融合内固定术，其中脊髓主要受压节段采用椎体次全切除减压，脊髓次要受压节段行椎间隙减压。观察手术并发症情况及术后1周、6个月、12个月时JOA评分、颈前柱高度与颈椎曲度C值的恢复情况。结果：手术时间90～160min，平均105min；术中出血量100—350ml，平均200ml。术后1例出现饮水呛咳，术后2周恢复正常；2例出现声音嘶哑，经对症处理均于术后1个月内恢复正常。随访12～24个月，平均14．0＋3．1个月。术后6～12个月均获骨性愈合，末次随访时无假关节形成和内固定松动或断裂。术后l周、6个月、12个月时颈前柱高度、颈椎曲度C值及JOA评分均较术前明显提高（P〈0．05）。术后12个月JOA评分改善率为（68-38±11．07）％，按改善率评定手术疗效，优11例，良17例，好转4例。结论：颈前路椎体次全切除联合椎间隙减压融合内固定术是治疗多节段颈椎病一种安全、有效的方法。

Objectives： To investigate the clinical outcomes of subtotal corpectomy combined with discectomy for multilevel cervical spondylosis. Methods： A total of 32 consecutive patients with multilevel cervical spondylosis undergoing subtotal corpecomy combined with disceetomy from March 2002 to January 2012 was- retrospectively reviewed. This case series included 20 males and 12 females with an average age at surgery of 52.32~5.73 years（range, 48 to 76 years）. Cervical spondylotic myelopathy was determined in 26 cases and mixed cervical spondylopathy in 6 cases . Three levels were involved in 29 cases, while four levels were in- volved in 3 cases. The mean preoperative JOA score was 8.07±1.82 （5-11）; the anterior column height was 67.29±2.63（61.98-73.01）mm; and C value of cervical curvature was 2.86~2.63[（-3.14）-8.42]. Anterior hybrid decompression and fusion was performed in all patients. In addition, the anterior column height and C value of cervical curvature were assessed radiographically at routine postoperative intervals of 1 week and 6, 12 months respectively. Results： The operation time was 105rain in average（from 90 to 160min）, and the amount of bleeding was 200ml in average （from 100 to 350m1）. 1 case with postoperative choke cough and 2 cases with hoarseness improved gradually after correspondent treatment. All cases were regularly followed up for 12- 24 months, with an average of 14.0±3.1 months. Solid fusion in all eases was noted 6-12 months later. No instrument failure was noted. The anterior column height, C value of cervical curvature and JOA scores signif- icantly increased at 1 week, 6 and 12 months after operation（P〈0.05）. The improvement rate of neurological function was （68.38±11.07）% at 12 months after operation, with 11 excellent, 17 good and 4 fair. Conclusions： Subtotal vertebrectomy combined with anterior decompression through cervical disc space and fusion is safe and effective for multilevel cervical spondylosis.