手术治疗29例重度颈椎病

Surgical treatment on 29 cases of severe cervical spondylotic myelopathy

目的：探讨手术治疗重度颈椎病的临床疗效。方法对29例重度颈椎病患者行手术治疗，前路手术8例，后路手术20例，分期后路-前路联合手术1例。比较手术前后JOA评分并计算术后3、6、12、24个月及末次随访的改善率，定期复查MRI了解脊髓神经情况。结果患者均获得随访，时间24-50（36．5±4．0）个月。JOA评分：术前6．1分±2．1分；术后3个月为6．5分±2．4分，改善率为4%±2%；术后6个月为7．1分±3．2分，改善率为9%±4%；术后12个月为10．7分±3．5分，改善率为42%±15%；术后24个月为11．3分±3．6分，改善率为48%±18%；末次随访时为11．9分±3．8分，改善率为53%±17%。末次随访优2例，良18例，可9例。定期复查MRI可见手术节段脊髓减压充分，椎管通畅程度进行性好转。结论重度颈椎病手术治疗有效，但脊髓神经功能恢复难以达到满意程度。

Objective To explore clinical efficacy of surgical treatment on severe cervical spondylotic. Methods A total of 29 cases suffering severe cervical spondylotic myelopathy were performed surgical treatment, 8 cases were re-ceived anterior approach surgery, 20 cases were received posterior approach surgery, 1 case was received combined both approach surgery. JOA score was used to analyze and compare preoperative with postoperative condition, and im-provement rate of postoperative 3,6,12,24 months and last follow-up were calculated;regular MRI examination was used to observe spine nerves condition. Results Twenty-nine patients got 24-50（36. 5 ± 4. 0） months follow-up. Preoperative JOA score was （6. 1 ± 2. 1） points; after 3 months, JOA score was （6. 5 ± 2. 4） points, improvement rate was 4% ± 2%;6 months later, reached （7. 1 ± 3. 2） points, improvement rate was 9% ± 4%;12 months later, （10. 7 ± 3. 5） points, improvement rate was 42% ± 15%;24 months later, （11. 3 ± 3. 6） points, improvement rate was 48% ± 18%;at the last follow-up, JOA score reached （11. 9 ± 3. 8） points,the improvement rate was 53% ± 17%. As a whole, 2 cases were in excellent condition, 18 cases were in good condition, the rest 9 cases were just ac-ceptable. Regular MRI examinations showed that spine marrow within surgical part got sufficient decompression, and spinal canal patency was improved obviously. Conclusions Surgical treatment on severe cervical spondylotic my-elopathy is effective,yet the recover of marrow nerve function is difficult to achieve satisfactions.