经肌间隙入路椎板下扩大成形治疗多节段脊髓型颈椎病

Application of the expanding forming under the plate through cervical spatium intermusculare approach in treating multi segmental myelopathic cervical spondylosis

目的 ：探讨应用经肌间隙入路颈椎板下扩大成形治疗多节段脊髓型颈椎病的手术方法与效果。方法 ：自2005年7月至2013年6月,采用经肌间隙入路颈椎板下扩大成形治疗多节段脊髓型颈椎病25例,男16例,女9例;年龄35~78岁,平均56.5岁。无诱因缓慢发病10例,无诱因突然发病7例,轻度外伤或劳累后发病8例。并通过JOA评分、术后轴性症状发生率及影像学检查评价手术疗效。结果：25例均获随访,时间6个月~7年6个月,平均2年9个月。手术后无感染与脑脊液漏,无神经损害加重等并发症发生,手术时间120~150 min,出血量300~500 ml。影像学检查：椎管矢状径增加,椎管横截面面积明显扩大,脊髓膨隆良好,颈椎曲度变直4例中2例恢复正常序列,无新增颈椎后凸、节段不稳加重病例。术后行走能力增强,大部分患者手指活动灵活性改善,握力增加,用筷进食准确性提高,肢体麻木和胸腰部束带感有不同程度减轻,术前大小便功能障碍者均有不同程度改善。术前JOA评分3~13分,平均（8.86±4.25）分;术后12个月JOA评分7~17分,平均（13.76±3.56）分,改善率为60.19%,手术前后JOA评分比较差异有统计学意义（P〈0.05）,其中优14例,良6例,中4例,差1例。结论：应用经肌间隙入路颈椎板下扩大成形治疗多节段脊髓型颈椎病,通过肌肉间隙入路,既可以保留颈椎后方肌肉完整,维持颈椎稳定;同时椎管又可以获得有效的减压。

Objective：To investigate the application of the expanding forming under the plate through cervical spatium intermusculare approach to treat multi segmental myelopathic cervical spondylosis. Methods：From July 2005 to June 2013,25 patients with multi segmental myelopathic cervical spondylosis were treated by the expanding forming under the plate through cervical spatium intermusculare approach including 16 males and 9 females with an average age of 56.5 years old ranging from35 to 78 years old. Among them,10 cases were onset without causes slowly,7 cases were onset without causes suddenly,8 cases were onset after mild trauma or tired. JOA scoring,incidence of postoperative axial symptoms and imaging studies were used to evaluate the effect. Results：Twenty five cases were followed up for 6 months to 7 years and 6 months with an average of 2years and 9 months. There were no infection,cerebrospinal fluid leakage after the operation,and complications such as nerve damage were occurred. The operation time was 120 to 150 min,the bleeding was 300 to 500 ml. Imaging examination showed vertebral canal sagittal diameter increased,the vertebral canal increased significantly in the cross sectional area of the spinal cord,cervical curvature was straighten in 4 cases（2 cases of them became normal sequence）. There were no more cases of cervical protruding and segmental instability increased. Postoperative walking ability enhanced,the finger activity of majority of patients improved on flexibility,grip strength,and accuracy of using chopsticks improved,numbness and chest waist band feeling had different degree of reduce,preoperative urine impairment were improved to varying degrees. Preoperative JOA scores were 3 to 13 points with an average of（8.86±4.25） points; Postoperative 12 months＇ JOA scores were 7 to 17 points with an average of（13.76±3.56） points,period was 60.19% in average,JOA score had statistically difference between before and after operation（P〈0.05）. The result were excellent in 14 cases,good in 6 cases,and fair in 4 cases and poor in 1 case. Conclusion：Application of the expanding forming under the plate through cervical spatium intermusculare approach to treat multi segmental myelopathic cervical spondylosis,through muscular clearance,can retain complete cervical back muscle,maintain stability of cervical spine,and vertebral canal can get effective decompression at the same time.