前后路联合颈椎管扩大成形术治疗脊髓型颈椎病

Expansive Cervical Laminoplasty by Anterior and Posterior Cervical Decompression in the Treatment of Cervical Spondylosis Myelopathy

目的 评价前后路联合颈椎管扩大成形术治疗脊髓型颈椎病伴发育性颈椎管狭窄的临床效果。方法 回顾性分析我科于 1995年 3月～ 2 0 0 0年 8月间应用该手术方式治疗的 32例脊髓型颈椎病患者 ,其中 ,男 2 1例 ,女 11例 ,年龄 38～ 72岁 ,发育性颈椎管狭窄合并颈椎间盘退行变突出 2 5例 ,发育性颈椎管狭窄发育合并后纵韧带钙化 7例 ;术前和术后通过神经功能JOA评分 ,颈部轴性症状和颈椎动态侧位片 ,颈椎MRI进行比较临床疗效。结果 全部病例获得随访 ,平均随访年龄 5 8 9岁 ,平均随访 2 4 3月。 32例患者术后 3月、6月、1年、3年 ,JOA评分平均改善率分别为 5 8 1%、6 5 9%、6 9 1%、6 8 4 %;优良率分别为 71 9%、81 3%、78 1%、77 3%,颈部轴性症状减轻 ,随访时X线检查未见不稳 ,MRI示颈髓压迫解除。结论 前后路联合颈椎管扩大成形术治疗脊髓型颈椎病合并发育性颈椎管狭窄是一种疗效好且稳定的手术方法。

Objective To evaluate the clinical results of expansive cervical laminoplasty by anterior and posterior cervical decompression in the treatment of Cervical Spondylosis Myelopathy with developmental cervical stenosis.Methods Retrospective analyze 32 patients of cervical spondylosis myelopathy treated with expansive cervical laminoplasty by anterior and posterior cervical decompression from Mar 1995 to Aug 2000 years, there were 21 males and 11 females, developmental cervical stenosis (DCS) with cervical intervertebral disc protrusion in 25 cases, with the ossification of cervical posterior longitudinal ligament (OPLL) in 7 cases. Neural functionality (JOA Scoring System), cervical axial symptoms, and pre-and post-surgery dynamic cervical spine lateral x-ray films and cervical vertebra MRI were evaluated. Results 32 cases had been followed up for an average of 24.3 months, with an average age 58.9 years (range 38-72). The average rate of improvement of the third and sixth in month postoperative,the first and third postoperative year was 58.1%,65.9%,69.1% and 68.4% respectively;the excellent and good was 71.9%,81.3%,78.1%,77.3% respectivery. Cervical axial symptoms were reduced. Instability of the cervical spine were not found and decompression was confirmed on MRI. Conclusion Expansive cervical laminoplasty by anterior and posterior cervical decompression in the treatement of cervical spondylosis myelopathy with developmental cervical stenosis have good efficacy and it is a stable operative method.