颈椎病外科治疗选择及远期疗效评价

目的研究脊髓型颈椎病经手术治疗的远期疗效及影响疗效的因素.方法报告4 585例脊髓型颈椎病,对发病因素、病程及影像学表现进行分析.全部实施颈前路减压及自体髂骨移植融合术,其中335例于术后6个月～2年再次手术.术后985例随访5年7个月～17年,平均7年7个月.结果功能评价,优476例(48.32%)、良335例(34.01%)、可94例(9.54%)及差80例(8.13%).手术疗效与病变严重程度、病程长短、减压程度和颈椎稳定性相关,病程在6个月内的患者疗效优于1年以上者(P<0.01).结论脊髓型颈椎病前路手术减压远期效果是肯定的;手术时机、病理变化程度及手术技术等对治疗效果有明显影响.

Long-term Evaluation and Choice of Surgical Treatment for Cervical Spondylosis

Objective:To observe the long-term outcome of a nterior decompression for cervical spondylotic myelopathy(CSM) and factors affec ting the outcome. Methods: Nine hundred and eighty-five cases of CSM were revie wed, and their pathogenesis, history and imaging characterization were analyzed. All were treated with anterior cervical decompression and auto iliac bone graft fusion. Thirty-five cases had revision surgery 6 months to 2 years after initi al o perations. Results: Function evaluation revealed excellent in 476 cases (48.32%) , good in 335 cases (34.01%),fair in 94 cases (15.04%), and poor in 80 cases (8. 13%). Forty-five cases were between 31 to 36 points. It was found that the dura tion of illness played an important role in the final outcome. Those with histor y of illness of less than 6 months had better results than that of more than 1 y ear ( P <0.01). Conclusion: The long-term results of surgical treatment for CSM is definite. Significant factors affecting the outcome include timing of ope ration, degree of pathology and technique of surgery.