颈前路椎体次全切减压钛网植骨融合联合钛板固定治疗多节段脊髓型颈椎病

Anterior corpectomy decompression and titanium mesh bone graft fusion combined with titanium plate fixation for the treatment of the multilevel cervical spondylotic myelopathy

目的 ：探讨颈前路椎体次全切减压钛网植骨融合联合钛板固定治疗多节段脊髓型颈椎病的临床疗效。方法：对2010年10月至2013年1月收治的48例多节段脊髓型颈椎病患者进行回顾性分析,其中男37例,女11例;年龄37-76岁,平均54.6岁;2个节段病变35例,3个节段病变7例,4个节段病变6例。所有患者接受颈前路椎体次全切钛网自体颗粒骨植骨融合颈前路钛板内固定手术。进行临床和影像学随访,记录术前及术后3、6、12个月及末次随访时的ROM、JOA、VAS及SF-36评分,观察融合程度和椎管减压情况。结果：所有患者获得随访,时间14-48个月,平均27.3个月。术后12个月时,影像学资料显示所有患者达到骨性融合,椎管减压彻底,术前病变最严重处椎管矢状径为（5.13±1.32）mm,术后12个月为（9.94±1.22）mm,手术前后椎管矢状径比较差异有统计学意义（t=2.463,P=0.014）;椎管减压程度为（92.15±2.35）%。术后各观察时间节点ROM、JOA、VAS及SF-36评分均较术前明显改善（P0.05）。结论 ：颈前路椎体次全切减压钛网植骨融合联合钛板内固定手术治疗多节段脊髓型颈椎病融合率高,减压彻底,临床症状体征改善明显,且安全性较好。

Objective：To explore the clinical effects of anterior corpectomy decompression and titanium mesh bone graft fusion combined with titanium plate fixation in treatting multilevel cervical spondylotic myelopathy. Methods：The clinical data of 48 patients with multilevel cervical spondylotic myelopathy underwent surgical operation were retrospectively analyzed from October 2010 to January 2013. There were 37 males and 11 females,aged from 37 to 76 years old with an average of 54.6 years.Thirty-five cases were two-segment lesion,7 cases were three-segment lesion,6 cases were four-segment lesion. All the patients were treated by anterior corpectomy decompression and titanium mesh bone graft fusion combined with titanium plate fixation. ROM,JOA,VAS and SF-36 scores were recorded before and after operation（including 3,6,12 months after operation and final follow-up）. Fusion degree and spinal canal decompression condition were observed by radiographic data. Results：All patients were followed up from 14 to 48 months,with an average of 27.3 months. At 12 months after surgery,radiographic data showed that all patients obtained bony fusion,spinal canal decompression were sufficient. Preoperative vertebral canal sagittal diameter of the most serious segment were（5.13±1.32） mm,12 months after surgery were（9.94±1.22） mm,there was statistically significance（t=2.463,P=0.014）;the degree of vertebral canal decompression were（92.15 ±2.35）%. Postoperative ROM,JOA,VAS and SF- 36 scores were obviously improved than that of preoperative（P〈0.05）; there was no statistically significance of ROM,JOA,VAS and SF-36 scores in each time after operation（P〉0.05）. Conclusion：Anterior corpectomy decompression and titanium mesh bone graft fusion combined with titanium plate fixation can obtain higher fusion rate,complete thoroughly decompression,improvement of clinical symptoms and well safety in treating multilevel cervical spondylotic myelopathy.