前路选择性椎体切除分节段减压植骨融合术治疗多节段脊髓型颈椎病

Selective Anterior Corpectomy Combined with Segmental Discectomy and Fusion for Multilevel Cervical Myelopathy

目的探讨前路选择性椎体切除分节段减压植骨融合术治疗多节段脊髓型颈椎病的疗效。方法对37例多节段脊髓型颈椎病患者采用前路选择性椎体切除分节段减压植骨融合术治疗,观察并记录手术基本情况、并发症发生情况及治疗前后JOA评分及颈椎矢状面活动度(ROM)变化情况。结果 37例患者平均手术时间(2.16±0.48)h,平均术中出血量(239.83±24.16)m L,平均住院时间(4.75±1.39)d,患者骨性融合率97.30%。5例患者出现吞咽困难,1例患者出现脑脊液漏,3例患者出现取骨区疼痛,全部患者无明显严重并发症发生。患者术前、术后6个月、术后12个月ROM、JOA评分对比差异有统计学意义(P<0.05),患者术后6个月、术后12个月ROM显著低于术前(P<0.05),患者术后6个月、术后12个月JOA评分显著高于术前(P<0.05)。结论前路选择性椎体切除分节段减压植骨融合术治疗多节段脊髓型颈椎病的疗效确切。

Objective To evaluate the clinical effect of selective anterior corpectomy combined with segmental discectomy and fusion for multilevel cervical myelopathy. Methods Thirty-seven cases of patients with multilevel cervical myelopathy were treated with selective anterior corpectomy combined with segmental discectomy and fusion. The surgery situation, complications, JOA scores and range of motion（ROM） of cervical spine before and after treatment were observed and recorded. Results The average operation time was（2.16 ±0.48） h, the average bleeding volume during operation was（239.83 ± 24.16） m L, and the average length of hospital was（4.75 ± 1.39） d. The solid fusion rate was 97.30%. A total of 5 patients had dysphagia, 1 patient had cerebrospinal fluid leakage and 3 patients had donor site pain;No serious complication was found in all patients. The ROM and JOA score before surgery, 6 months and 12 months after surgery were significantly different（P〈0.05）. The ROM at 6thmonth and 12 thmonth after surgery were significantly lower than that before surgery（P〈0.05）,and the JOA score at 6thmonth and 12 thmonth after surgery were significantly higher than that before surgery（P〈0.05）. Conclusions The clinical effect of selective anterior corpectomy combined with segmental discectomy and fusion for multilevel cervical myelopathy is significant.