脊髓型颈椎病手术失误原因分析与对策

Analysis of Mistherapy of Cervical Spondylosis Myelopathy and the Countermove of It

目的 提高脊髓型颈椎病 (CSM)的疗效 ,避免手术失误。方法 回顾性分析 10例 CSM手术失误原因 ,并对其施行了单开门颈椎管扩大成形术 ,其中 9例得到了随访 ,随访时间 2周～ 8个月。结果 CSM伴发育性颈椎狭窄(DCS)组 6例 ,JOA评分平均改善率 6 3.5 3%。 CSM伴后纵韧带骨化 (OPL L )组 3例 ,JOA评分平均改善率 73.6 6 % ,获得满意疗效。失误原因有三方面 :1CSM伴 DCM后路单开门范围不够 ,应从 C3 ～ C7,而不是 C3 ～ C5。 2 CSM伴 OPL L连续型、节段型 ,经前路减压不彻底 ,且有脊髓损伤的危险。 3神经根型颈椎病 ,不宜按 CSM行单开门椎管扩大成形术。结论 正确选择适应证和严格的手术操作是减少失误。

Objective To improve efficacy of treatment of the cerviacl spondylosis myelopathy and to avoid misplay during operation.Methods The mistherapy reasons for 10 cases of CSM were retrospectively analyzed.All the 10 cases were operated with expansive open door laminoplasty of cervical spine,nine of which had been followed up for from 2 weeks to 8 months.Results Satisfactory results were obtained among the DCS(6 cases) and OPLL(3 cases),with an average JOA recovery rate being 63.53% and 73.66% respectively.Three reasons were among the displays:①Inadequate range of open door laminoplasty of cervical spine of from C 3 to C 5 rather than from C 3 to C 7.② Incomplete decompression of continuous type ,the segmental type and surgical excision through anterior cervical spine among the CSM accompanied by OPLL with the potential danger of injury of spinal cord at the same time.③The cervical spondylosis radiculopathy being not suitable to open door laminoplasty.Conclusion It was key factors to choose indication correctly and perform the operation seriously if less display and improved efficacy were expected.