前路减压术治疗脊髓神经根型颈椎病临床疗效观察

目的探讨前路减压融合手术治疗脊髓神经根型颈椎病的疗效及注意事项。方法对56例脊髓神经根型颈椎病患者（其中1个节段20例、2个节段19例、3个节段17例），分别采用经前路椎间隙扩大式潜行减压术或椎体次全切除加扩大式开槽减压术，两侧潜行减压的宽度标准为20mm（或该椎弓根间距80％以上），直视下彻底切除增生肥厚的后纵韧带和两侧钩椎关节后外缘骨赘、椎体上下缘骨赘等，同时松解颈髓和两侧神经根袖部。37例取自体髂骨植骨，12例采用椎间融合器，7例采用钛网植骨。所有患者均行颈椎前路钛板固定。结果本组患者得到平均18个月随访，植骨在13～17周内融合，无骨不连、假关节发生；颈椎生理曲度维持良好；无钛板、螺钉等内固定物松动或损坏。神经功能JOA评分由术前平均（9．42±2．64）分上升到术后1个月时平均（1387±242）分（P〈0.01）。结论脊髓神经根型颈椎病前路手术中，两侧潜行减压的宽度达到20mm（或该椎弓根间距的80％以上），同时松解硬膜囊和两侧神经根袖部，可取得良好的疗效。

Anterior expansive decompression in treatment of cervical spondylotic myelopathy and radiculopathy

Objective To assess the clinical value of anterior expansive decompression in treatment of cervical spondylotic myelopathy and radiculopathy. Methods Fifty six patients with cervical spondylotic myelopathy and radiculopathy were admitted from March 2003 to June 2008, including 20 cases with one intervertebral disc involved, 19 cases two discs involved and 17 cases three discs involved. All patients were treated with anterior wide decompression through the intervertebral space or by corpectomy, and cervical spine locking plate fixation. The standard decompression width was 20 ram. Thirty seven cases were submitted to auto iliac bone graft, 12 cases were implanted with intervertebral fusion cage and 7 cases with titanium mesh, all were filled with cancellous bone of resected vertebra body. Results After surgery patients were followed up for 18 months in average. Solid fusion was obtained in 13 -17 weeks postoperatively. The restoration of intervertebral spaces was maintained after operation. The physiological curve of cervical spine was satisfied. No complications occurred such as breaking of the plate and screw. The JOA score rose from 9.42 points preoperatively to 13.87 points postoperatively. Conclusion Anterior wide decompression and fusion of cervical spine is a feasible procedure with advantage of safety, complete decompression and reliable bone fusion for patients of cervical spondylotic myelopathy and radiculopathy.