前路减压植骨结合锁定板内固定治疗脊髓型颈椎病

目的:探讨颈椎前路减压植骨结合锁定钛板内固定治疗脊髓型颈椎病的疗效。方法:回顾性分析前路椎体次全切减压,取髂骨植骨或钛网植骨结合前路锁定钛板内固定术治疗118例脊髓型颈椎病的疗效;根据术前、术后即刻及术后随访颈椎标准X线片,测量融合节段Cobb角、融合节段椎体前缘高度(HAB)及后缘高度(HPB)并评估植骨融合情况;JOA标准评价神经功能情况。结果:随访6-32个月,平均19个月;3例出现钛网轻度沉陷,所有病例无内固定断裂、松动,末次随访骨融合率为100%;JOA评分,术前与术后即刻及末次随访时比均存在显著差异(P<0.05),优良率为86.2%;术后Cobb角、HAB及HPB值与术前比较有明显改善,差异有显著性(P<0.05);术后随访与术后即刻上述指标值比较均无显著性差异(P>0.05)。结论:颈椎前路减压植骨结合锁定板内固定治疗脊髓型颈椎病,减压彻底,有效的矫正了颈椎畸形并达到坚固骨融合、重建稳定的目的,临床效果满意。

Treatment of Cervical Spondylotic Myelopathy by Anterior Cervical Corpectomy and Bone Graft Fusion with Cervical Spine Locking Plate

Objective: To investigate the clinical outcome of cervical spondylotic myelopathy(CSM) by the treatment of anterior decompression and internal fixation with locking plate.Methods: A total of 118 cases of CSM underwent anterior corpectomy decompression,ilium or titanium mesh cage implantation combined with locking plate fixation were retrospectively studied.X-ray films were analyzed and JOA scores were determined.Cobb's angle and intervertebral height(height of anterior border,HAB;height of posterior border,HPB) were measured to evaluate the vertebral fusion.Results: All 118 cases were followed up for 6 to 32 months(average 19 months).According to JOA scoring,the ratio of improvement in neurological function was 83.9% and the final fusion rate was 100%.Only three cases had subsidence of titanium mesh slightly,and there were no fractures and loose in internal fixations.Immediate postoperative X-ray film showed the obvious improvement in lordosis and intervertebral height of the cervical spine(P<0.05),and no changes(P>0.05) happened during the follow-up.Conclusion: After thorough decompression,effective correction of kyphosis deformity,stable spinal reconstruction and solid graft fusion,patients with CSM can be successfully treated with the procedures of anterior cervical corpectomy and bone graft fusion with cervical spine locking plate.