一期后前路手术治疗多节段脊髓型颈椎病

One-stage Posterior-anterior Decompression and Stabilization for Multilevel Cervical Spondylosis

目的 探讨治疗多节段重度脊髓型颈椎病的手术方式及疗效。方法 采用一期后路“双开门”椎板成形、侧块钛板固定加前路减压支撑植骨钛板固定术治疗术前MRI显示三个节段以上 (含三个节段 )颈脊髓前后方受压 ,X线动态片显示颈椎失稳或后突畸形的 2 0例脊髓型颈椎病。结果 一期后、前路手术 2 0例 ,手术时间平均 5 5h (5～ 7h) ,失血量平均 5 0 0ml。术后 1～ 2d病人戴颈围离床活动 ,颈围外固定 1 2周 ,所有病例随访 6～ 1 8个月 (平均 1 0个月 ) ,无伤口感染 ,未见颈椎内固定及植骨块松脱移位 ,X线摄片显示术后 4个月前方植骨块与椎体融合。临床颈痛消失 ,四肢神经症状按Nurick分级均较术前上升一级以上 ,平均从术前 3 3级升至术后 2 4级。结论 一期后、前路颈椎管减压、内固定、植骨融合术为复杂棘手的多节段的脊髓型颈椎病手术治疗提供了一种比较安全、可靠的方法。在达到充分解除颈脊髓前后压迫同时稳定颈椎 ,预防了前方支撑植骨的松脱、颈椎的后突畸形发生 。

Objective To explore the surgical technique on treatment for cervical myelopathy with multilevel cervical spondylosis. Methods Twenty patients underwent posterior open door laminoplasty and lateral mass plating with autografting,anterior cervical copectomies with strut autografting and self lock plating was performed in all cases while the same anesthetic agent was still in effect. Results In our series,the average total operative time was 5 5 h(5～7 h) and average blood loss was 500 ml.Postoperatively,patients left bed in 2 days with cervical colar which was used until the 12th week.All cases were followed from 6 to 10 months with average 10 menths.There were no wound infection,strut graft extrusion and instruments failure.Evidence of anterior fusion was observed on radiography after 4 months.Clinical neurological symptoms of all patients were improved by at leaset one Nurick grade,the mean Nurick grade improved from 3 3 preoperatively to 2 4 postoperatively. Conclusion One stage posterior anterior decompression and stabilization provides a reliable safety technique,allows us directly to make the completely decompression followed immediately restore stability,prevents anterior strut graft extrusion and finally achives a high rate of fusion for surgical treatment for cervical myelopathy with multilevel complex spondylosis.