中老年颈脊柱前纵韧带断裂伴颈脊髓损伤前路手术疗效分析

目的探讨颈前路减压融合内固定治疗中老年颈脊柱前纵韧带断裂无骨折脱位型颈脊髓损伤患者的临床疗效。方法回顾性分析2007年1月至2011年12月期间，伴前纵韧带断裂无骨折脱位型颈脊髓损伤28例中老年患者，采用颈椎前路减压cage置入椎体间融合Zephir钢板内固定的临床资料。结果28例患者均获随访20~60个月，平均36个月。每例患者手术时间30~55min，平均40min，出血量20~110ml，平均50ml，术后1例出现吞咽异物感，1周后症状消失；1例出现脑脊液漏，经留置引流管2周换药后创面完全愈合；无喉返神经及椎动脉损伤；住院时间平均8d；脊髓功能按Frank分级平均提高1．5级；随访X线片示椎间融合良好，内固定物稳定，无螺钉松动及假关节形成；椎间高度及颈椎生理曲度维持良好。优良率：优19例、良8例、差1例，优良率为96．4％。结论颈前路减压融合内固定治疗伴前纵韧带断裂无骨折脱位型颈脊髓损伤中老年患者，疗效满意，是一种安全、可靠、有效的手术方式，值得，陆床推广应用。

Objective To investigate the cliniccal effect of anterior cervical decompression and fusion with internal fixation in the treatment of elderly patients with rupture of anterior longitudinal ligament of cervical spinal cord injury without fracture and dislocation. Methods A retrospective study was performed on 28 cases of elderly patients with rupture of anterior longitudinal ligament of cervical spinal cord injury without fracture and dislocation in the treatment of interbody fusion with Cage and Zephir plate from Jan 2007 to Dec 2011. Results All patients were followed up for 20 to 60 months （ average 36 months ） . The operation time is about 30 to 55 minutes （ average 40 minutes ） and blood loss was 20 to 110ml （ average 50ml ） .All patients without recurrent laryngeal nerve and vertebral artery injury. 1 cases of cerebrospinal fluid leakage was wound healing by after drainage tube with 2 weeks .According to Frank classification, the spinal cord function increase of 1.5 grade. The X films showed good internal fixation and stable interbody fusion, no looseness and pseudarthrosis; intervertebral height and cervical curves maintain good. The excellent and good rate was 96.4% （ excellent in 19 cases, good in 8 cases and poor in 1 cases ） . Conclusion Anterior cervical decompression and fusion with internal fixation in the treatment of elderly patients with rupture of anterior longitudinal ligament cervical spinal cord injury without fracture and dislocation has advantages such as small trauma, good cervical vertebra stable, which was a safety, reliable and effective surgery way, can obtain satisfied cliniccal efficacy in elderly patient.