发育性颈椎管狭窄合并脊髓型颈椎病的临床特征与手术疗效

目的探讨发育性颈椎管狭窄合并脊髓型颈椎病的临床特征与手术治疗效果。方法 89例发育性颈椎管狭窄合并脊髓型颈椎病患者采用颈椎体次全切除治疗42例,Cloward环锯法手术27例,采用单开门颈椎管扩大成形术20例。前路手术同期均采取自体髂骨植骨融合。结果本组患者无手术并发症发生。89例获12～56个月的随访,平均随访（16.8±2.6）月,按照JOA评分系统评价治疗效果,术前评分平均（9.5±0.3）分,术后6、12个月评分平均（13.1±0.2）分、（14.2±0.4）分,术后6、12个月JOA评分与手术前比较差异有统计学意义（P〈0.05）,术后6、12个月JOA平均改善率57.2%、64.3%。结论对于发育性颈椎管狭窄合并脊髓型颈椎病前路、后路各种术式有着各自不同的适应证,选择合理的治疗手段十分重要。

Clinical characteristic and the surgical treatment effect of developmental cervical stenosis accompanied with cervical spondylotic myelopathy

Objective To explore the clinical characteristic and the surgical treatment effect of developmental cervical stenosis accompanied with cervical spondylotic myelopathy. Methods 89 patients of developmental cervical stenosis accompanied with cervi- cal spondylosis myelopathy were treated by operation. Including 42 cases were treated by subtotal vertebrectomy of the cervical spine, 27 by Cloward method, and 20 by the single-open-door cervical laminoplasty. Anterior fusion with grafting was performed in all these cases. Results No complications had happened in the serial 89 cases were followed up for 12 to 56 months, with an average of （ 16.8 ± 2.6） months. These cases were evaluated using the scoring system of the Japanese orthopedics association （JOA score）. The average JOA score was （9.5 -＋0.3） pre-operatively. The average JOA score was （ 13.1 ±0.2） on the sixth month af- ter operation. The average JOA score was （14.2 ±0.4） on the first year after operation. The difference of the average JOA score had statistical significance （ P 〈 0. 05 ）, compared it on the sixth month after operation and on the first year after operation with it before operation. The improve rate of the average JOA score was 57.2% on the sixth month after operation, 64.3% on the first year after operation. Conclusion Both anterior and posterior surgical procedures are safe and effective methods for the treatment of developmental cervical stenosis accompanied with cervical spondylotic myelopathy. It is important for clinician to select a reasonable treatment.