颈前路联合手术治疗多节段脊髓型颈椎病

Anterior cervical hybrid surgical treatment for multilevel cervical spondylotic myelopathy

目的:评价颈椎前路椎间隙减压自锁融合器结合前路短节段钢板固定治疗多节段脊髓型颈椎病的临床效果。方法:对2012年1月至2015年6月采用颈椎前路椎间隙减压自锁融合器结合前路短节段固定钢板治疗的106例多节段脊髓型颈椎病患者的临床资料进行回顾性分析,男71例,女35例;年龄42~74岁,平均(55.4±5.1)岁。受累节段:3节段82例,4节段24例。记录手术时间、术中出血量、术后引流量及住院时间;分析术前,术后5 d,术后3、6、12个月及末次随访时颈肩痛视觉评分(VAS)和日本骨科协会(JOA)评分,并计算出JOA改善率;测量术前,术后3、6、12个月及末次随访时颈椎曲度和颈椎ROM。对术后并发症进行统计分析。结果:106例手术均顺利进行,手术时间为(126.2±25.1)min,失血量为(82.1±26.3)ml。所有患者获得随访,时间12~48个月,平均(30.4±10.5)个月。颈肩痛VAS评分和JOA评分分别由术前的6.11±1.54、9.22±2.42改善为术后5 d的2.14±0.51、12.46±1.42(P<0.05),术后各时间点VAS及JOA评分比较差异无统计学意义(P>0.05),术后5 d JOA改善率达(56.7±21.6)%,术后各时间点JOA改善率比较差异无统计学意义(P>0.05)。颈椎生理曲度术后3个月为(19.6±8.9)°比术前的(11.5±6.8)°明显改善(P<0.05),术后能够获得比较满意的稳定(P>0.05);而颈椎ROM由术前的(37.6±10.4)°减少为术后3个月的(18.2±5.9)°,颈椎活动减少明显(P<0.05),随访过程中无明显改变(P>0.05)。术后出现吞咽困难19例,轴性痛6例,脑脊液漏3例,声音嘶哑2例,保守治疗好转;3例患者各有1个椎间隙未融合(无临床症状),未出现内固定松动、断裂、移位。结论:颈椎前路椎间隙减压自锁融合器结合前路短节段钢板固定,能够减少术中损伤,恢复颈椎生理曲度,改善脊髓神经功能,减少术后并发症,是治疗多节段脊髓型颈椎病的可选方案。

Objective ：To evaluate the clinical results of anterior cervical discectomy and reconstruction with a self-lock- ing cage and internal fixation with short segmental plate for multilevel cervical spondylotic myelopathy. Methods：From Jan- uary 2012 to June 2015, a total of 106 patients received anterior cervical discectomy and reconstruction with a self-locking cage and internal fixation with short segmental plate were followed up. There were 71 males and 35 females, aged from 42 to 74 years old with an average of （55.4±5.1） years. Three segments were involved in 82 cases and four segments in 24 cases. Operation time, blood loss, postoperative drainage, and hospitalization time were recorded. Visual analogue scale （VAS） and Japanese Orthopaedic Association Score （JOA） were analyzed before and after operation （including 5 days, 3,6,12 months after opera- tion and final follow-up）,and the JOA improvement rate was analyzed. The cervical lordosis and ROM were measured before and after operation （including the follow-up point above） by X-rays. The postoperative complications were recorded and ana- lyzed as well. Results ： All the operations were successful. The average operative time was （ 126.2±25.1 ） min, and the amount of blood loss was （82.1±26.3） ml. All the patients were followed up from 12 to 48 months with an average of （30.4±10.5） months. The VAS score of neck pain and JOA score was significantly better from 6.11±1.54 and 9.22±2.42 preoperatively to 2.14±0.51 and 12.46±1.42 at 5 days post-operation,respectively（P〈0.05）. The improvement rate of JOA was （56.7±21.6）%, there was no statistically significant difference of VAS ,JOA scores and the improvement rate of JOA at each time after opera- tion （P〉0.05）. Postoperative cervical lordosis at 3 months was significantly improved from preoperative （11.5±6.8）° to （19.6± 8.9） °（P〈0.05 ）, and it can keep satisfactory stability until final follow-up （P〉0.05）. Postoperative ROM at 3 months was signifi- cantly decreased from the preoperative （37.6±10.4）° to （18.2±5.9）°（P〈0.05） ,but there was no significant change in the pro- cess of follow-up （P〉0.05）. All the complications such as dysphagia （19 cases）, axial neck pain （6 cases ）, cerebral fluid leak- age （3 cases ）, and hoarseness （2 cases）, got better after conservative treatment. Three cases had intervertebral space non-fusionuntil final follow-up （without clinical symptom）, but no loosening, breakage, or displacement of internal fixation were found. Conclusion：Anterior cervical discectomy,reconstruction with a self-locking cage and internal fixation with short segmental plate which can reduce intraoperative injury,restore cervical lordosis,improve neurological function and lower postoperative complications, it is an alternative treatment for multilevel cervical spondylotie myelopathy.