经显微镜下颈前路手术治疗颈椎病效果观察

Effects of Microscopic Anterior Cervical Approach in Cervical Spondylotic Diseases

目的探讨显微镜下颈椎前路手术治疗颈椎病的手术疗效。方法选择在显微镜下采用经颈椎前路椎体次全切减压,钛网置入融合内固定术或颈椎间盘切除减压cage置入内固定术治疗的颈椎病患者75例。其中1个椎间隙41例,2个椎间隙30例,3个椎间隙4例。术后定期随访,采用日本矫形外科学会评分系统(JOA)评分法分别对患者术前和术后末次随访时脊髓功能进行评分,并计算神经功能改善率,以此评定显微镜下颈椎前路手术的临床疗效。结果 75例患者均获得随访,其神经功能改善情况为优44例,良25例,可6例,优良率为92%,各椎间隙组间优良率比较,差异无统计学意义。各椎间隙组内患者术后末次随访JOA评分均高于术前(均P<0.05)。结论显微镜下颈椎前路手术治疗颈椎病安全有效,术中创伤小,出血少,减压彻底,术后恢复快,可早期下床活动,治疗效果满意。

Objective To assess the curative effect of microscopic anterior cervical approach in cervical spondylotic diseases. Methods A total of 75 patients were selected, who underwent microscopic subtotal anterior cervical decompres-sion and titanium mesh to fusion fixation or microscopic decompression of resection of the cervical intervertebral disc and cage implant fixation in Tianjin People＆#39;s Hospital since October 2011 to October 2012. The Cervical vertebra gap involved 1 level in 41 cases, 2 levels in 30 cases and 3 levels in 4 cases. Pateints followed up regularly after operation. The nerve func-tion was assessed using Japanese orthopaedic association scoring system （JOA） function was calculated to examine the im-provement rate and to assess the curative effect of microscopic anterior cervical approach. Results All patients were fol-lowed up. The nerve function recovery was excellent in 44 cases, was well in 25 cases, was general in 6 cases, and the ex-cellent and well recovery rate was 92%. There was no significant difference between excellent recovery rate and well recov-ery rate. There were significant differences in values of each cervical levels between before and after surgery in the last fol-low-up of patients （P＆lt;0.05）. Conclusion Microscopic operative treatment for cervical spondylotic is safe and effective, with less trauma and bleeding. After surgical decompression, the recovery is rapid in patients with early ambulation.