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颈椎病外科治疗的回顾
引用本文:孙宇,刘忠军,党耕町.颈椎病外科治疗的回顾[J].北京大学学报(医学版),2002,34(5):627-629.
作者姓名:孙宇  刘忠军  党耕町
作者单位:^A北京大学第三医院骨科,北京,100083^B北京大学医学部附属第三医院(北医三院)^C1447
摘    要:为进一步阐明颈椎病的发病机制以及外科治疗的原理和适应证,回顾分析1959年12月至2000年10月期间手术治疗的各型颈椎病5 198例.对有关颈椎病的发病机制、临床诊断与治疗的实验与临床研究的结果进行概括、总结和分析.认为:(1)神经根型、交感型、椎动脉型多数采取保守治疗,而脊髓型颈椎病多采用手术治疗.保守治疗的目标不在于清除压迫神经、血管的骨刺或椎间盘,而在于消除该部位因不稳定造成的创伤性炎症.(2)发育性颈椎管狭窄与脊髓病的发生有密切关系,是脊髓型颈椎病发病的重要因素之一.在颈椎侧位X线平片上,C3~C6任何一节椎管中矢状径与椎体中矢状径的比值小于或等于75%即为发育性颈椎管狭窄.(3)颈椎病的发病是神经、血管的压迫与相应节段的不稳定两个因素共同作用的结果.(4)多节段脊髓受压者,宜采用后路椎管扩大术.脊髓单节段或二个节段受压而无椎管狭窄者、颈椎后凸畸形或有明显不稳定者,应当采用前路减压、椎体间植骨融合术.

关 键 词:颈椎病/外科学  椎管狭窄/外科学  外科治疗  
文章编号:1671-167X(2002)05-0627-03

Review of surgical treatment on cervical spondylosis
Abstract:In order to further reveal the pathogenic mechanism, principle and indication of surgical treatment of cervical spondylosis, 5 198 cases operated during the period of Dec. 1959 t o Oct. 2000 were reviewed. The results of both experimental and clinical studies related to the pathogenic mechanism, diagnosis and treatment of cervical spondyl osis were collected, summarized and analyzed retrospectively. It was found: (1) The aim of conservative treatment was to clear the traumatic inflammation around the neuro-vascular structures due to instability rather than to remove the com p ression due to spur and prolapsed intervertebral disc. (2) There was a very clos ed relationship between myelopathy and the developmental stenosis of cervical sp inal canal and that should be considered if the ratio of sagital diameter of spi nal canal and vertebral body is or less than 75% at any segment from C3 to C6 on the lateral view X-rays. (3) The presentation of cervical spondylosis is the r e sult of both factors of neuro-vascular compression and segmental instability wo r king together. (4) In the case of multi-segmental spinal cord compression, lami noplasty should be performed. Single or double level compression without stenosi s of spinal canal can be decompressed anteriorly.
Keywords:Cervical spondylosis/surg  Spinal stenosi s/surg  Surgical treatment
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