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颈椎病伴椎管狭窄手术入路的选择
引用本文:藏磊,刘忠军,党耕町,刘晓光.颈椎病伴椎管狭窄手术入路的选择[J].中国矫形外科杂志,2006,14(9):653-656.
作者姓名:藏磊  刘忠军  党耕町  刘晓光
作者单位:北京大学第三医院骨科,北京市海淀区花园北路49号,100083
摘    要:目的]探讨颈椎病伴椎管狭窄时的治疗策略及手术入路选择,为颈椎病手术治疗提供有益的经验。方法]通过收集2002年7月~2003年12月间颈椎病伴椎管狭窄经前路减压术后疗效不佳或症状复发的病例,经分析后再次行后路减压手术治疗并观察其近期疗效;同时随机抽取1985年4月~1992年5月间病情相似而行后路减压的一组病例进行远期疗效随访,对比两组术后疗效。结果]经前路减压术后脊髓功能(JOA)改善率仅为11.7%,但经后路者为70.3%;而前者经后路减压再手术后脊髓功能改善率可提高至52.8%。结论]颈椎病伴颈椎管狭窄病例经前路减压术后疗效不佳或症状复发的主要原因在于椎管狭窄因素仍然存在,对上述病例行后路减压再手术治疗后,仍可取得一定的疗效;而最初便经后路减压治疗的此类患者则可取得较显著的远期疗效,提示经后路多节段减压可一期有效地扩大颈椎椎管,从而提高手术治疗颈椎病的疗效。

关 键 词:脊髓型颈椎病  椎管狭窄  后路  外科治疗
收稿时间:2005-12-08
修稿时间:2005年12月8日

Choice of surgical approaches in cervical spondylotic myelopathy with stenosis of cervical spinal canal
ZANG Lei,LIU Zhong-jun,DANG Geng-ting,LIU Xiao-guang.Choice of surgical approaches in cervical spondylotic myelopathy with stenosis of cervical spinal canal[J].The Orthopedic Journal of China,2006,14(9):653-656.
Authors:ZANG Lei  LIU Zhong-jun  DANG Geng-ting  LIU Xiao-guang
Institution:Department of Orthopaedics Surgery, the 3^rd Hospital of Peking University, Beijing 100083
Abstract: Objective ] To discuss the strategy of surgery and the choice of surgical approaches for cervical spondylotic myelopathy with stenosis of cervical spinal canal in order to offer helpful experience to the treatment of cervical spondylotic myelopathy. Method] The cases of cervical spondylotic myelopathy with stenosis of cervical spinal canal which had poor outcome, or recurred decompressed by anterior approach during the period of Jul. 2002 to Dec. 2003 were collected, and after analyzing, another decompression by posterior approach were performed and the short-term follow-up were undergone ; meanwhile, the patients in the similar condition but by posterior approach only during the period of Apr. 1985 to May. 1992 were drawn randomly, and the long-term follow-up were carried out, and the results were compared. Result] The recovery rate of the spinal cord function in the patients who were decompressed by anterior approach was only 11.7%, but the posterior one was 70. 3%, and the recovery rate of the former patients decompressed again by posterior approach improved to 52. 8%. Conclusion] The main cause of poor outcome, or recurrence decompressed by anterior approach lies in the stenotic factors of spinal canal still existing, and good outcome can still be obtained in a certain extent when another surgical decompressions by posterior approach were performed. However, the patients decompressed by posterior approach initially have achieved a much better outcome in the long-term followed-up. All these indicate that the decompression by posterior approach can enlarge the cervical spinal canal efficiently in one-stage, and improve the curative effect for surgical treatment of cervical spondylotic myelopathy indeed.
Keywords:Cervical spondylotic myelopathy  Stenosis of spinal canal  Posterior approach  Surgical treatment
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