颈椎前路椎体致压物复合体前移融合术治疗多节段脊髓型颈椎病的手术技巧及临床分析

Surgical skills and clinical analysis of anterior controllable antedisplacement and fusion in the treatment of multiple segmental cervical spondylotic myelopathy

背景:多节段脊髓型颈椎病的手术方案选择存在着一定的争议。目的:探讨颈椎前路椎体致压物复合体前移融合术(anterior controllable antedisplacement and fusion, ACAF)治疗多节段脊髓型颈椎病的手术技术要点及临床疗效。方法:我科2017年6月至2017年8月应用ACAF治疗多节段脊髓型颈椎病患者13例,男8例,女5例,年龄43～73岁,平均58.5岁。采用日本骨科学会(Japanese Orthopaedic Association, JOA)评分,评价手术前后脊髓功能;同时进行颈椎功能障碍指数(Neck Disability Index, NDI)评价。测量手术前后颈椎曲度、术前责任节段Polvo比值,颈椎矢状位MRI上测量手术前后责任节段纤维性椎管的矢状径,颈椎横断面CT测量手术前后责任节段骨性椎管矢状径及术后椎体后缘开槽宽度。结果:本组患者术后随访3～5个月,平均3.3个月;1例术后出现吞咽不适感,2例术后早期出现单侧上肢无力。末次随访时,JOA评分及NDI指数较术前明显改善(P<0.01);术后早期颈椎曲度、术后颈椎的纤维性椎管及骨性椎管的矢状径较术前明显增大(P<0.01)。结论:颈椎前路椎体致压物复合体前移融合术是治疗多节段脊髓型颈椎病安全有效的手术方式之一,尤其是合并颈椎管狭窄的患者,具有独特的优势。

Background： There are some controversies about the choice of surgical procedures for multiple segmental cervical spondylotic myelopathy. Objective： To evaluate the early clinical effect of anterior controllable antedisplacement and fusion（ACAF） on the multiple segmental cervical spondylotic myelopathy and to analyse the key points of ACAF. Methods： Thirteen patients with multiple segmental cervical spondylotic myelopathy treated by ACAF from June 2017 to August 2017 were enrolled in this study. There were 8 males and 5 females with an average age of 58.5 years（range, 43-73 years）. Japanese Orthopaedic Association（JOA） score and Neck Disability Index（NDI） were used to evaluate the clinical efficacy. Cervical lordosis angle, midsagittal diameters of fibrous spinal canal and osteal spinal canal of the operated levels were measured preoperatively and postoperatively. Moreover, the Polvo ratio of lesion segment in the cervical spine was measured preoperatively, and the width of the posterior margin of the vertebral body of operative segment was evaluated postoperatively. Results： All the patients were followed up and the median follow-up duration was 3.3 months（range, 3-5 months）. One patient had dysphagia and two presented with unilateral upper limb weakness postoperatively. The JOA score and NDI were significantly improved at the final follow-up（P〈0.01）. Postoperative cervical lordosis angle and the midsagittal diameters of fibrous spinal canal and osteal spinal canal of the operated levels were significantly larger than the preoperative ones（P〈0.01）. Conclusions： ACAF surgery is an safe and effective treatment alternation for multiple segmental cervical spondylotic myelopathy, espcially for the patients with cervical spinal stenosis. It can achieve satisfactory clinical outcome at the early follow-up.