颈椎翻修手术的原因及对策

目的 探讨颈椎翻修术的适应证、手术方式及其临床疗效.方法 自1998年4月～2007年12月,对21例颈椎手术后患者进行了翻修手术.翻修手术距离首次手术的时间2～42个月,平均15.3个月.所有病例均出现临床症状,其中表现为放射性颈肩痛16例、颈部活动受限5例,原有的脊髓受压表现加重8例,再次出现新的脊髓压迫症状7例.首次手术的术前诊断包括:下颈椎骨折脱位6例,神经根型颈椎病2例,脊髓型颈椎病9例,颈椎不稳4例.手术方式包括:单纯前路减压加自体髂骨植骨4例,前路减压加颈椎前路钢板固定8例,前路减压加Cage融合2例,前路椎体次全或全切除加内固定3例,后路CerviFix单纯内固定3例,后路双开门减压1例.结果 本组术后疗效优良13例(61.9%),好转6例(28.6%),无效及加重各1例(9.5%).21例术前评分2～14(8.65±0.37)分,术后8～16(14.27±0.69)分,差异有显著性(P<0.01).植骨于术后3～6个月融合.未出现喉上、喉返神经损伤、气管食管漏、脑脊液漏以及呼吸系统并发症.结论 颈椎翻修术式视具体情况而定,术前宜详细制定手术方案,彻底减压与正确的固定是手术成败的关键.

Cause and Countermeasure in Cervical Revision Surgery

Objective To discuss the indications,operative methods and clinic curative effects of the cervical revision surgery.Methods Twenty-one cases of cervical vertebrae post-operation underwent cervical revision operation between April 1998 and September 2007.The time of revision from the first operation was 4 to 28 months with an average 15.3 months.All patients represented clinic symptoms,including scruff pains 16 ones,cervical motion restricted 5 times;the previous spine cord symptoms aggravated 8 ones,new spi...