脊髓型颈椎病前路减压内固定价值

The Value of Anterior Approach Decompression and Internal Fixation in Cervical Spondylotic Myelopathy

目的 :评价脊髓型颈椎病前路减压后应用内固定的价值。方法 :对 112例脊髓型颈椎病患者采用经前路减压、自体髂骨或钛质网笼植骨及AO颈椎带锁钢板内固定 ,获得随访 10 4例 ,平均随访时间 30个月 ,观察植骨融合率、融合节段椎间高度和颈椎生理曲度维持情况以及内植物并发症 ,并对神经功能恢复进行评价。结果 :94例单节段和两节段病变者术后 3个月内获得牢固骨性融合 ,融合率为 10 0 % ,10例三节段手术者融合率为 80 % ,内植物并发症为 2 .9%( 3/10 4)。全部病例术后椎间高度和生理曲度维持满意 ,JOA评分由术前平均 10 .3分提高到术后平均 14 .8分 ,平均改善率为 6 7.2 %。结论 :脊髓型颈椎病前路手术后采用内固定可显著提高植骨融合率 ,并有效地维持椎间高度和颈椎生理曲度 。

Objective:To evaluate the value of internal fixation after anterior approach decompression surgery in Cervical Spondylotic Myelopathy(CSM).Methods:112 cases of CSM were treated with anterior decompression,iliac crest autograft or titanium cage bone graft and AO cervical spine locking plate(CSLP),and 104 cases were followed up to observe the fusion rate of bone graft,the height of interbody in fusion level,the maintaining condition of cervical spine lordosis and the complications of implanted materials and to evaluate the rehabilitation of the neurological function with an average follow up of 30 months.Results:94 cases with single or two level lesions gained solid bone fusion during 3 months post operation with a fusion rate of 100%,whereas 10 cases with three level lesion showed a fusion rate of 80% and a complication rate of implanted materials of 2.9%(3/104).All cases gained satisfied height of cervical interbody and lordosis and the average JOA scale increased from 10.3 to 14.8 post operatively,with an average improving rate of 67.2%.Conclusion:The internal fixation in anterior approach surgery in CSM has widely application value,which can significantly improved the fusion rate of bone graft and effectively maintain the height of anterior column and cervical lordosis.