摘要
目的:总结后路单开门与一期前后路联合手术减压治疗前后受压脊髓型颈椎病的疗效,探讨一期前后路联合减压的手术适应证。方法:1996年2月至2007年12月,对67例前后方均受压的脊髓型颈椎病患者分别采用后路单开门神经根管扩大减压术(A组,36例)或一期前后路联合减压术(B组,31例)治疗。随访患者临床和影像学情况,手术前后按日本矫形外科学会(JOA)评分标准评定神经功能,计算改善率,比较两组临床疗效。结果:A组手术时间1～1.5h,平均72min;术中出血量110～500ml,平均370ml;无明显术中并发症发生,术后1例出现肩部放射痛。B组手术时间3～5h,平均3.6h;术中出血量400～1300ml,平均710ml;术中出现脑脊液漏4例。随访6个月～8年,平均28个月,前路植骨及后路门轴全部骨性愈合。A组神经功能改善率为72.4%,优良率为80.1%;MRI检查显示34例脊髓明显后移、前后方软性压迫解除、脑脊液通畅,2例显示脊髓明显后移、前方仍存在骨化块轻度压迫,予以二期前路骨化块切除减压、内固定术,随访时21例显示前方椎间盘突出明显消失或缩小;CT显示椎管扩大充分,开门度数平均为63.2°。B组神经功能改善率为74.1%,优良率为80.6%;MRI显示31例脊髓前后方压迫均解除、脑脊液通畅;CT显示椎管扩大充分,开门度数平均为53.3°。两组神经功能改善率和优良率均无统计学差异。结论:后路单开门减压治疗前方软性压迫的前后受压脊髓型颈椎病可使脊髓充分后移躲避前方的压迫,术后脊髓前方的软性压迫缩小或消失,疗效肯定;但对椎管狭窄合并脊髓前方超过椎管50%的骨性压迫者疗效欠佳,应采用一期或二期前后路联合减压治疗。
Objective：To investigate the clinical outcome and indication of posterior single-door laminoplasty and combined posterior-anterior decompression for severe cervical spondylosis.Method：Retrospective analysis of 67 cases with severe cervical spondylosis was performed,two different surgical protocols were assigned as follows：group A had 36 cases undergoing routine posterior laminoplasty and decompression and group B had 31 cases undergoing combined anterior and posterior decompression.JOA（Japanese Orthopedic Association） score system was used to evaluate the neurofunction.The clinical outcome between two groups were reviewed and compared.Result：In group A,the surgical time was 1-1.5h（mean,72min）,blood loss was 110-500ml（average,370ml）.No intraoperative complication was noted except shoulder radiated pain in 1 case.While in group B,the counterparts were 3-5h（mean,3.6h） and 110～500ml（mean,710ml） respectively.CSF leakage was noted in 4 cases.All cases were followed up for 6 months to 8 years（mean,28 months）,anterior bony graft and door axial had bony union.Group A had neurofunction improve rate of 72.4%,excellent to good rate of 80.1%,MRI showed spinal cord moved dorsally and decompression in 34 cases,while 2 cases had still bony compressed ventrally despite of complete canal enlargement which was followed by anterior decompression.CT showed the door open degree was 63.2°.In group B,the neurofunction improve rate was 74.1% with excellent to good rate of 80.6%,MRI showed spinal cord moved dorsally and decompression in 31 cases,CT showed the door open degree was 53.3°,which showed no significant difference between two groups.Conclusion：The posterior laminoplasty for spinal cord compression both ventrally and dorsally can have spinal cord moved dorsally and make the anterior compressor retract or disappear,however for those having canal stenosis over 50%,this protocol is not applicable,combined anterior and posterior approach should be considered.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2010年第3期197-200,共4页
Chinese Journal of Spine and Spinal Cord
关键词
脊髓型颈椎病
颈椎管狭窄
椎间盘突出
单开门手术
前后路手术
Cervical spondylotic myelopathy
Cervical stenosis
Single-door laminoplasty
Anterior and posterior approach
作者简介
男（1971-），副主任医师，医学学士，研究方向：脊柱、关节外科电话：（0395）3356027 E-mail：71561yw@sina．com
