多节段脊髓型颈椎病后路显微减压及融合术的疗效观察

Clinical observation of effects of posterior microdecompression and fusion on multilevel cervical spondylotic myelopathy

目的探讨多节段脊髓型颈椎病(CSM)后路显微减压及内固定融合术的疗效。方法回顾性分析2014年3月至2017年12月采用后路减压并内固定植骨融合术治疗的32例多节段CSM的临床资料。结果术后随访3~12个月,平均(28.7±8.2)个月。术后3个月[(14.76±2.4)分]、术后6个月[(15.3±2.1)分]、术后12个月[(15.48±2.3)分]改良日本骨科协会量表评分较术前[(11.24±2.8)分]均显著改善(P<0.05)。32例术后均复查颈椎CT和MRI平扫,显示置钉位置满意,脊髓减压良好,减压上下缘无明显压迫点。32例中,仅1例术中出现大出血,出血量约为3000 ml;其余31例失血量不超过200 ml。术后出现C5神经根麻痹1例,3个月后症状好转;出现轴性疼痛、肌肉间隙积液各1例。结论后路长节段显微减压术是治疗多节段CSM的有效方式,规范手术操作有利于减少并发症。

Objective To analyze the improvement of neurological function and complications after posterior microdecompression and internal fixation fusion in the patients with multilevel cervical spondylotic myelopathy(CSM).Methods A retrospective analysis of the clinical data of 32 patients with multilevel CSM,who underwent posterior microdecompression and fusion from 2014 to 2017,was made.The neurological function was assessed by modified Japanese Orthopedic Association(mJOA)scores before the operation and 3,6 and 12 months after the operation.The change in the postoperative spinal imaging and postoperative complications including the intraoperative hemorrhage,C5 nerve root paralysis,axial pain,infection and so on were observed.Results The microdecompression of spinal long segment including C3~C7 and C3~T1 were successfully performed.All the patients were followed up from 3 to 12 months.The mJOA scores were significantly higher 3,6 and 12 months after the operation than that before the operation(P<0.01).One patient suffered from massive hemorrhage during the operation due to the rupture of the venous plexus.One patient developed C5 nerve root palsy and the symptoms were significantly improved 3 months after the operation.One patient developed significant axial pain and mended by the treatment.One patient had effusion in the intermuscular space,which was absorbed one month later.MRI showed that the effect of decompression on spinal cords were good in all the patients.Conclusion The posterior long segment microdecompression is an effective method to treat the multilevel CSM.