颈椎前路手术钢板内固定适应证的探讨

The Indications of the Front-cut Surgeries of Inner Fixing with Steel Plate in Cervical Vertebra

目的:探讨颈椎前路手术钢板内固定的适应证。方法:10例单一颈椎间盘突出症(包括外伤性单一颈椎间盘突出),2例局限性后纵韧带骨化症(一个椎节范围),17例多节段脊髓型颈椎病中的9例,8例无脱位的下颈椎骨折(包括4例爆裂型骨折)行前路减压、自体髂骨植骨;2例节段性后纵韧带骨化症(OPLL),17例多节段脊髓型颈椎病中的8例,6例下颈椎骨折、脱位行前路减压、自体髂骨植骨,并行带锁钢板内固定。结果:共计45例手术中38例平均随访7.6个月,植骨于术后12～16周骨性融合者36例(钢板固定者15例获随访,均骨性融合)。术后恢复之椎间高度未发生再丢失现象,颈椎生理曲度维持良好者29例。手术总有效率为94.7％(36/38),优良率为84.3％(32/38)。脊髓型颈椎病及OPLL JOA评分由术前的平均8.4分上升至术后的13.9分。结论:多节段脊髓型颈椎病、节段性OPLL(2～3个节段)、不稳定的下颈椎椎体骨折(包括爆裂型骨折、半脱位、全脱位、韧带结构损伤)压迫脊髓者均宜行前路开槽减压、植骨及带锁钢板内固定;单一颈椎间盘突出(包括外伤性颈椎间盘突出),局限性OPLL(一个节段内),无脱位的下颈椎椎体骨折(压迫脊髓)可行颈前路单纯减压、植骨;若超过1个以上的椎体骨质切除较多时,宜加钢板内固定。

Objective:To probe into the indications of the front-cut surgeries of inner fixing with steel plate in cervical vertebra. Methods:29 cases were treated with decompression and self-hipbone transplanting: 10 cases with single protrusion of cervical interver-tebral disc;2 with ossifications of limitative back-longitudinal ligament;9 with polyarthric spinal-marrow-related cervical vertebra dis-eases;8 with lower cervical vertebra fracture without dislocation. 16 patients were treated with front-cut decompression, self-hipbone transplanting and inner fixing of steel plate with locks:8 cases with polyarthric spinal-marrow-related cervical vertebra diseases ;2 with ossifications of polyarthric back longitudinal ligament (OPLL) (within one vertebra) ;and 6 with lower cervical vertebra fracture and dislocation.Results:38 out of 45 patients were followed up for 7.6 months on average;36 cases showed fusion of bones in 12 ~ 16 weeks after operation( All 15 cases of fixing with steel plate were followed up and showed fusion of bones) .There were 29 cases whose restored intervertebral height had not been lost and the phisiological bending of their cervical vertebra maintained good conditions. 94.7% of the operations was effective,with an efficacy rate of 84.3% .The evaluation marks of spinal-marrow-related cervical vertebral patients,OPLL and JOA were elevated from 8.4 before operation to 13.9 after it.Conclusion:All patients with polyarthric spinal-marrow-related cervical vertebra diseases,OPLL(2 ~ 3 joints) and unsteady lower cervical vertebral fracture resulting in constriction of spinal marrow are fit for preoperative decompression, bone transplating and inner fixing of steel plate with locks. The patients with single profusions of cervical intervertebral disc,limitative OPLL (within one vertebra),steady lower cervical vertebral fracture should be given single front cervical decompression and bone transplanting. However, if more than one vertebral bone have been removed, fixing with steel plate is necessary.