颈椎病前方入路术后恢复不良的原因分析

１９８０年１２月至１９９３年１２月，我科经前方入路治疗颈椎病并获随访１８３例，其中３７例（２０．２％）术后恢复不满意，ＪＯＡ恢复率小于６０％。根据主诉与症状，我们把这些病人分成４组。（１）术后症状立即加重，１年内仍无改善者４例。（２）术后症状无明显改善，１年后仍无进步者１１例。（３）术后症状减轻，但经过一段时间后，原症状又复出现者８例。（４）双下肢症状好转，但又出现新的上肢症状或上肢原症状加重者１４例。结合术后Ｘ线、ＣＴ、ＭＲＩ和椎管造影等检查所见，我们将发现的主要问题归纳为手术操作、病情发展演变、原有胸腰椎病和脊髓受压变性等情况。本文对以上发生的问题进行了分析，提出在以后的手术中应特别注意的事项。

Analysis of causes of unsatisfactory postoperative results of cervical spondylopathy treated by anterior approach

This paper reports follow-up results of 183 patients with cervical spondylopathy treated by anterior approach between Dec,1980 and Dec. 1993. In which , 37 patients whose JOA recovery retio less than 60% divided into 4 groups according to their postoperative symptoms and signs:(1) the sympotoms became sever after operation in 4 cases;(2) the symptoms had not been improved obviously for more than one year after operation in 11 cases; (3) the symptoms recurred again after duration of improvement in 8 cases, and (4)the sympotoms of lower extremities improved but the sympoms apperared or aggravated on upper extremities in 14 cases. Combined analysis of postoperative X-film, CT, MRI and myelogram, the principal problems of unfavourable results were :(1) bony spurs were not complately removed;(2) spondylotic changes are still progressing;(3) combined with thoracic and(or) lumbar spondylosis;(4) degeneration of spinal cord.