颈后路锚钉置入治疗颈椎管狭窄合并脑梗死:对脑循环的影响较小

Anchor fixation in posterior surgery for cervical spinal canal stenosis combined with cerebral infarction shows less effect on the cerebral circulation

背景:高龄颈椎手术同时合并脑梗死风险较高,保守治疗又往往无法解决严重的颈椎病变。目的:探讨颈椎管狭窄脑梗死患者后路锚钉内固定的治疗效果。方法:回顾性分析5年收治的21例颈椎管狭窄症合并脑梗死的患者,经过充分的围手术期准备,均采用颈后路单开门椎管扩大成型、侧块带线锚钉固定并按JOA标准评定疗效。结果与结论:所有病例获得6个月至2年(平均15个月)的随访,均安全渡过围手术期,无急性严重脑梗死病例的出现。治疗前JOA评分为(7.6±2.0)分,内固定后1年JOA评分为(13.3±1.8)分,治疗前后比较差异有显著性意义(P<0.01)。其中优11例,良7例,有效率为95%(20/21),优良率为86%(18/21)。结果说明此手术对合并脑梗死患者风险较大,但不是绝对禁忌证,选择恰当的手术方式,以带线锚钉固定的颈后路单开门椎管扩大成型对脑循环影响较小,可降低脑血管意外的风险,临床疗效满意。

BACKGROUND： There is a high risk for the elderly cervical spine surgery combined with cerebral infarction, whereas conservative treatment is often unable to resolve serious cervical lesions. OBJECTIVE： To discuss the surgical effects of anchor fixation via posterior approach on cervical spinal canal stenosis combined with cerebral infarction. METHODS： A total of 21 patients with cervical spinal canal stenosis combined with cerebral infarction who were admitted over the past 5 years accepted cervical posterior expensive open-door laminoplasty and fixation with wire anchors. Therapeutic effects were evaluated according to the Japanese Orthopaedic Association （JOA） scores. RESULTS AND CONCLUSION： All the patients were followed up 6 to 24 months, averagely 15 months. All patients were smoothly through the perioperative period. There were no acute severe cerebral infarction cases. Preoperative JOA score was （7.6±2.0） points averagely, and postoperative JOA score was （13.3±1.8） points averagely, showing a significant difference （P 〈 0.01）. Of the 21 patients, excellent effects were in 11 cases and good in 7 cases. The effective rate was 95% （20/21）, and the excellent-good rate was 86% （18/21）. The risk of surgical treatment of patients with cerebral infarction is higher, but it is not the absolute contraindication. Choosing the proper operation way is highly important. Cervical posterior expensive open-door laminoplasty and fixation with wire anchors can be used to reduce the risk of cerebrovascular accidents to some extent, and obtain an excellent clinical effect.