Hybrid Surgery术式治疗颈前路多节段脊髓型颈椎病的临床分析

Clinic analysis of Hybrid Surgery to treat multi segmental anterior cervical spondylotic myelopathy

目的探讨颈椎前路经椎间隙或椎体次全切除减压植骨融合联合邻近节段人工间盘置换（Hybrid Surgery）在颈前路多节段脊髓型颈椎病治疗中的效果。方法应用Hybrid Surgery术式治疗颈前路多节段脊髓型颈椎病患者18例。随访1~50个月,手术前后根据日本骨科协会评估分数（JOA）进行评分。通过JOA评分的改善情况,Odom’s分级随访结果及颈椎活动度的变化评价Hybrid Surgery的效果。结果 18例术后JOA评分（13.5±2.4）分高于术前（10.6±1.7）分,差异有统计学意义（t=1.314,P〈0.05）。18例中16例显效,2例有效。Odom’s分级评价优6例,良11例,可1例。术后颈椎运动范围（40.1°±8.4°）与术前（42.6°±11.9°）颈椎运动范围差异无统计学意义（t=0.68,P〉0.05）。结论 Hybrid Surgery术式颈前路充分减压融合,既可改善患者神经功能,又可保留一定程度上的颈椎活动度。

Objective To investigate the effect of corpectomy decompression by subtotal vertebrectomy and fusion ofadjacent segmental artificial disc replacement through anterior intervertenral spance（Hybrid Surgery） in the anteriorcervicalspondylotic myelopathy treatment. Methods Hybrid Surgery were operated on 18 patients who suffered from anterior cervi-cal spondylotic myelopathy. Follow up of 1-50 months. Patient＇s conditions were assessed according to the Japanese Associ-ation for Department of orthopedics assessment score（JOA score） before and after operation. Effects of Hybrid operationwere assessed by the improvement of JOA score, Odom＇s follow-up grade and cervical mobility. Results The JOA scoresof all 18 operated patients were improved from 10.6 ± 1.7 before operation to 13.5 ± 2.4 after operation. And the differenceis statistically significant（t=1.314, P〈0.05）. Among all the operated patients, 16 were cured and 2 were effective. As toOdom＇s follow up grades, 6 cases were excellent, 11 cases were good and 1 case was acceptable. The postoperative move-ment range of cervical spine（40.1° ± 8.4°） show no statistically difference compared with that in preoperation（42.6° ± 11.9°）（t=0.68, P〈0.05）. Conclusion Hybrid Surgery of anterior cervical decompression and fusion can both improve the nervefunction and preserve cervical mobility.