前路钢板在治疗颈椎骨折脱位中重建生理曲度的疗效评价

目的:评价前路带锁钢板系统在治疗颈椎骨折脱位中对恢复及维持颈椎前凸的应用价值。方法:对45例颈椎骨折脱位经前路减压、植骨,AO纯钛带锁钢板内固定病例,分别摄术前、术后即刻、术后随访时X线片,以Cobb角测量融合节段的前凸(或后凸),以D值(齿状突到C7后下缘连线与C4后下缘垂直距离)评价颈椎的前凸(或后凸)。对数据分别行配对t检验。结果:经9个月~3年随访(平均21.8个月),所有病例均获骨性融合。术前与术后即刻、术前与术后随访时Cobb角及D值差异有显著性(P<0.01);术后即刻与术后随访Cobb角及D值差异均无显著性(P>0.05)。结论:应用前路带锁钢板系统治疗颈椎骨折脱位在恢复和维持颈椎生理曲度方面效果满意。     

颈椎后前路减压内固定术翻修颈椎前路内固定失效的临床研究

目的:探讨颈椎后前路减压内固定术翻修颈椎前路内固定失效的临床疗效及并发症预防。方法:2008年1月至2011年12月,采用颈椎后前路联合减压内固定手术治疗颈椎前路内固定失效17例,男12例,女5例;年龄26~68岁,平均44.1岁。其中内固定下位螺钉松动6例,上位螺钉松动5例,钛网沉陷3例,上位螺钉断裂2例,下位螺钉断裂1例。通过影像学观察患者的植骨融合情况,采用改良JOA(Japanese Orthopaedic Association Scores)17分评分法进行临床功能评价。结果:所有翻修手术顺利完成。1例术前凝血功能欠佳患者术后血肿,出现神经症状,予急诊血肿清除,输注新鲜冰冻血浆后,神经症状基本恢复。所有患者获得随访,时间6~38个月,平均(22.4±10.0)个月。术后2周、3个月、末次随访时JOA评分分别为13.1±1.6、13.4±1.6、14.2±1.5,均较术前明显改善。所有患者翻修后保留或更换的内固定物位置良好,在术后10个月时显示骨性融合,平均融合时间6个月。结论:采用后前路联合减压内固定翻修颈前路内固定失效安全性高,减压彻底,能够稳定减压节段,维持颈椎曲度,重建三柱稳定,可用于颈椎前路内固定失效患者的治疗。     

前路融合内固定方式对颈椎曲度的影响

目的分析颈椎前路减压融合术中,不同植骨融合内固定方式对恢复颈椎生理曲度的影响。方法2000年1月～2002年12月施行颈椎前路减压内固定手术治疗颈椎伤病患者67例,将26例单节段减压内固定病例分为前路钢板 髂骨植骨融合组(A组,11例)及Cage植骨融合组(B组,15例);将41例多节段(双或三节段)椎体次全切除减压内固定病例分为钢板 髂骨植骨融合组(C组,19例)及钢板 钛网植骨融合组(D组,22例)。以D值法(颈椎侧位X线片上,C4椎体后下缘到齿突后缘与C7椎体后下缘连线的垂直距离)分别比较A、B两组及C、D两组在恢复颈椎生理曲度方面的疗效。结果术后即刻A、B两组及C、D两组之间D值的增值差异无显著性(P >0.05)。全部病例随访10～36个月(平均21.5个月),均获骨性融合。A、B两组及C、D两组之间末次随访时D值增值差异无显著性(P >0.05),各组内术后即刻与末次随访时D值增值的差异无显著性(P >0.05),多节段减压组(C D组)与单节段减压组(A B组)D值增值在术后即刻与随访时差异均有显著性(P< 0.01)。结论在均行单节段或多节段减压融合的病例中,采用不同的前路融合内固定方式对恢复颈椎曲度无明显影响,由此推断正确掌握前路手术适应证是有效恢复颈椎生理曲度的首要因素,恢复颈椎生理曲度的关键步骤在术中而非术后。     

颈椎翻修手术的原因及对策

目的 探讨颈椎翻修术的适应证、手术方式及其临床疗效.方法 自1998年4月～2007年12月,对21例颈椎手术后患者进行了翻修手术.翻修手术距离首次手术的时间2～42个月,平均15.3个月.所有病例均出现临床症状,其中表现为放射性颈肩痛16例、颈部活动受限5例,原有的脊髓受压表现加重8例,再次出现新的脊髓压迫症状7例.首次手术的术前诊断包括:下颈椎骨折脱位6例,神经根型颈椎病2例,脊髓型颈椎病9例,颈椎不稳4例.手术方式包括:单纯前路减压加自体髂骨植骨4例,前路减压加颈椎前路钢板固定8例,前路减压加Cage融合2例,前路椎体次全或全切除加内固定3例,后路CerviFix单纯内固定3例,后路双开门减压1例.结果 本组术后疗效优良13例(61.9%),好转6例(28.6%),无效及加重各1例(9.5%).21例术前评分2～14(8.65±0.37)分,术后8～16(14.27±0.69)分,差异有显著性(P<0.01).植骨于术后3～6个月融合.未出现喉上、喉返神经损伤、气管食管漏、脑脊液漏以及呼吸系统并发症.结论 颈椎翻修术式视具体情况而定,术前宜详细制定手术方案,彻底减压与正确的固定是手术成败的关键.     

前路病灶清除植骨钛板内固定治疗下颈椎结核

[目的]探讨前路一期病灶清除、植骨内固定治疗下颈椎结核的手术方法及效果。[方法]30例下颈椎结核患者,术前四联抗痨治疗至少3周后,采用前路行一期病灶清除、前路减压及植骨内固定融合术。男22例,女8例;平均年龄为37岁。术前检查病变累及2个椎体者21例,3个椎体者9例。按Frankel分级:B级5例,C级5例,D级13例,E级7例。术前颈椎平均后凸角为12°。[结果]所有患者都能很好的耐受手术,术中显露清楚,病灶清除彻底。手术时间为70~100 min,出血量为50~150 ml。无手术并发症发生。所有患者均得到随访,随访时间24~36个月,平均30个月。末次随访中,23例合并有神经系统症状患者中,5例B级恢复到D级,3例C级恢复到D级,2例C级恢复到E级,13例D级恢复到E级。随访中结核病灶无复发,无断钉及内固定失效发生。椎间植骨均获骨性融合,融合平均时间为6.5个月。[结论]经前方入路一期病灶清除、植骨钛板内固定手术是治疗下颈椎结核的有效方法。     

钛质外科网和自体髂骨块在颈椎前路减压融合术中应用的对比性研究

目的:比较钛质外科网(简称“钛网”)与自体髂骨块在颈椎前路减压融合术中恢复、维持颈椎曲度及椎间高度上的差异。方法:对59例确诊为脊髓型颈椎病的患者行颈椎前路减压融合术,其中22例行钛网植骨加AO纯钛带锁钢板内固定,37例行自体髂骨块植入加AO纯钛带锁钢板内固定。分别摄术前、术后即刻、术后随访时的颈椎标准侧位X线片,以Cobb角测量融合节段的前凸(或后凸),以D值评价颈椎的前凸(或后凸),同时测量融合节段椎体前缘高度(HAB)、后缘高度(HPB)。对各参数不同时期间差值分别行组间配对t检验。结果:经9~18个月随访(平均10.8个月),所有病例均获骨性融合。术后3个月钛网组及自体髂骨块组融合节段后高(HPB)和前凸Cobb角相对于术后即刻变化有显著性差异(P<0.01);术后6个月钛网组及自体髂骨块组融合节段后高(HPB)和前凸Cobb角相对于术后3个月变化有显著性关(P<0.01)。但两组的D值无显著性差异。结论:在维持融合节段椎体后缘高度和前凸上钛网优于自体髂骨块,但在维持颈椎曲度上无显著性差异。     

颈椎射频消融术后颈椎感染的翻修手术治疗

目的 :分析颈椎射频消融术后颈椎感染的翻修手术效果。方法 :回顾性分析2010年7月~2016年7月在我科接受翻修手术的9例颈椎射频消融术后颈椎感染患者资料。其中男5例,女4例,年龄51.8±4.3岁(34~61岁),均在接受颈椎射频消融术后1周内(3~7d)神经症状再次出现或加重,其中5例患者神经症状加重程度超过射频消融术前,影像学检查和实验室检查提示存在颈椎感染,9例均存在椎间隙感染,3例伴有硬膜外脓肿,1例伴有椎体感染。入院后行翻修手术治疗,均行颈椎前路病灶清除+植骨融合内固定术,其中3例行椎体次全切除植骨融合内固定术,6例行椎间盘切除植骨融合内固定术。测量评估射频消融术前患者手术节段椎间隙的高度和椎间盘退变情况,用VAS评分评估患者翻修手术前后的颈部及上肢疼痛情况,用JOA评分评估翻修手术前后的神经功能情况。结果:射频消融术前,接受射频消融的11个节段椎间隙相对高度为0.19±0.07(0.14~0.25),Pfirrmann椎间盘退变分级为Ⅲ级4个节段、Ⅳ级7个节段。翻修术后所有患者颈部及上肢疼痛VAS评分及神经功能JOA评分较翻修术前明显改善(P0.05)。平均随访2.8年(1~3.6年)。末次随访时,患者颈部及上肢VAS评分由翻修术前的6.3±1.2分和5.8±2.1分改善到1.6±1.0分和1.5±0.9分(P0.05);JOA评分从翻修术前的9.5±3.8分改善到13.5±3.6分(P0.05)。随访期间未出现植骨不融合等其他并发症。结论:颈椎翻修手术是处理颈椎射频消融术后严重颈椎感染的有效方法。严格控制颈椎射频消融术适应证可以有效减少并发症发生。     

ACIF在颈前路减压融合术的应用

目的探讨Zero-P零切迹颈椎前路椎间融合固定系统(ACIF)在颈前路融合术中的临床疗效。方法回顾分析自2009-01-2010-12对36例颈椎患者采用的颈前路椎间盘切除减压Zero-P椎间融合术治疗。采用日本骨科学会(JOA)及视觉模拟评分(VAS)评分,观察术前、术后3天、3个月、12个月疗效。结果所有患者采用JOA评分,术前(8.57±1.03)分,随访终末评分(:14.3±1.22)分。VAS评分(:6.73±1.12)分,随访终末评分(2.03±1.06)分。术后12个月植骨融合率为100%,手术前Cobb角为11.2°(-5.5°~17.1°),随访终末Cobb角为15.7°(0°~19.1°)。术前与术后差异均有统计学意义(P<0.05)。术后均无感染、喉返神经、喉上神经及椎动脉损伤,切口均一期愈合,无翻修手术者。结论Zero-P零切迹颈椎前路椎间融合固定系统(ACIF)能使融合节段获得即刻稳定,融合率高,疗效满意,具有创伤小、神经损伤风险小、可预防临近节段的骨化、操作简便的优点。     

锚定式椎间融合器治疗下颈椎不稳症临床疗效评价

目的观察单独应用锚定式颈椎椎间融合器(anchoring cervical intervertebral fusion cage,ACIFC)植骨融合治疗下颈椎不稳症的临床疗效。方法回顾性分析2008年3月至2013年11月收治的下颈椎不稳症患者11例,其中男4例,女7例;年龄43~71岁,平均55.27岁。均采用前路椎间盘切除减压,单独应用ACIFC行植骨融合术。应用COA 40分法评价患者术前、术后即刻、末次随访时的颈脊髓功能改善情况,以Vaccaro标准评价手术节段融合情况。根据术后即刻同末次随访的X线片结果比较,将椎间高度变化大于等于2 mm视为融合器塌陷。结果 11例患者术后颈脊髓功能均获改善,末次随访同术前比较平均改善率为77.63%,术前COA评分同术后即刻、末次随访比较差异有统计学意义(P0.05)。手术节段均获骨性融合,融合时间2.8~5.2个月,平均3.89个月。将术后即刻椎间高度同末次随访时椎间高度比较,配对t检验比较差异无统计学意义(P0.05),11例患者椎间高度下降均小于2mm。结论单独应用ACIFC行椎间植骨融合治疗下颈椎不稳症融合率高,术后并发症低,能够有效恢复和维持椎间高度,无明显融合器塌陷,是传统前路颈椎间盘切除椎间融合联合内固定的较好替代方法。     

强直性脊柱炎并下颈椎骨折脱位手术治疗方法的选择

目的探讨强直性脊柱炎并下颈椎骨折脱位手术方法的选择及治疗要点。方法回顾性分析自2015-03—2018-10诊治的7例强直性脊柱炎并下颈椎骨折脱位,4例采用单纯后路长节段固定融合术治疗(后路组),2例采用前后联合入路手术治疗(联合入路组),1例采用单纯前路植骨融合内固定术治疗(前路组)。结果后路组1例术后1周出现肺部并发症而死亡,其余6例获得随访,随访时间平均18.7(3～21)个月。术后切口均一期愈合,未出现感染。6例均在术后3～5个月获得骨性愈合,无内固定松动、断裂发生。后路组末次随访时脊髓神经功能ASIA分级:1例B级无改善,1例B级改善至D级,1例D级改善至E级。前路组末次随访时脊髓神经功能ASIA分级无改善(C级)。联合入路组末次随访时脊髓神经功能ASIA分级:1例B级无改善,1例C级改善至D级。结论强直性脊柱炎并下颈椎骨折脱位行手术治疗能够获得即刻稳定,一定程度上改善了患者脊髓神经功能,术前应根据患者骨折情况及原有畸形制定个体化手术方案。     

颈椎前路融合术治疗下颈椎不稳定

目的评价颈椎前路融合术治疗下颈椎不稳定的临床效果。方法2000年10月至2004年10月,对67例X线片显示颈椎不稳定并伴有相应临床症状的颈椎病患者进行了前路融合手术,其中男性38例,女性29例;平均年龄33岁。颈椎不稳的X线判定标准为颈椎最大前屈和最大后伸侧位X线片测量相邻节段水平位移超过3.5mm或相邻椎体间成角大于11°者。手术方法为椎间植骨+钢板固定或融合器植骨融合。结果所有患者平均随访11个月,不稳椎节均得到融合稳定。大部分患者的术前症状获得了不同程度的改善,脊髓功能JOA评分由术前10.15增至术后14.95,差异有统计学意义(P<0.05);并发症包括术后钢板螺钉松动拔出2例,行翻修手术后恢复满意。结论对下颈椎不稳定患者,合理选择颈椎前路融合方法可获得满意的临床效果。     

Prediction of postoperative alignment in patients undergoing anterior cervical fusion using autologous vertebral bone grafting

Cervical anterior fusion is useful for the treatment of patients with cervical disease, but carries the risk of postoperative worsening of the cervical spine alignment and kyphosis. Preoperative prediction of the risk for kyphosis could help to avoid such postoperative complications. We attempted to predict the postoperative development of kyphosis in 59 patients scheduled for cervical anterior fusion using autologous vertebral bone grafting. Of these, 36 underwent single and 23 two level fusion with median follow up of 58.2 months. Whole spine alignment, fused segment alignment, and mobility of the intervertebral disc were compared using pre- and postoperative radiographs. Alignment of the whole spine changed from 13.7 degrees to 11.1 degrees , and the angle of the fused segment changed from 3.6 degrees to -3.2 degrees . Postoperative alignment was not worse than the preoperative flexion posture in any of the 59 patients. Forty-nine patients with preoperative lordotic alignment did not develop postoperative kyphosis. Nine patients with preoperative straight alignment had several types of postoperative alignment, including kyphosis. Two patients with postoperative kyphosis showed marked loss in the angle of the fused segment, which affected mobility to flexion of the fused segment. One patient with preoperative kyphotic alignment manifested postoperative kyphosis. The postoperative alignment was influenced by the preoperative alignment. Kyphosis may develop in patients with preoperative straight alignment and large mobility to flexion of the fused segment. This information is useful for surgical planning of anterior cervical fusion using autologous vertebral bone grafting.     

Kyphotic malalignment after anterior cervical fusion is one of the factors promoting the degenerative process in adjacent intervertebral levels

The aim of this study was to determine whether postoperative malalignment of the cervical spine after anterior interbody fusion surgery promotes degenerative changes in the neighboring intervertebral discs. Forty-two patients who underwent anterior interbody fusion surgery for cervical spondylosis and disc herniation (34 men, 8 women) were followed for an average of 9.8 years. The average age at surgery was 50.2 years. Twenty-three patients underwent a single-level fusion, 17 underwent two-level fusion, and 2 had three levels fused. The Japanese Orthopaedic Association cervical myelopathy score, with a normal score 17 points, was 11.7 before surgery and 14.9 at follow-up. Neurological status was significantly improved postoperatively, and the improvement was preserved thereafter in most cases (paired t-test, P<0.001). Degenerative changes were evident on radiological examination in the levels adjacent to the fused segment in 21 of the 42 (50%) patients. Eight of these 21 patients demonstrated neurological deterioration caused by an adjacent disc lesion. A total of 43% of the patients with adjacent-level degeneration had malalignment of the cervical spine, such as kyphosis or sigmoid curvature. In addition, degenerative change in adjacent intervertebral levels was observed in 77% of kyphoses of the fused segment. These were statistically significant (Fisher exact method, P<0.05, P<0.04, respectively). Our findings suggest that one of the factors promoting degenerative change in adjacent intervertebral levels after anterior cervical fusion for degenerative disorders is postoperative kyphotic change in the cervical spine and the fused segment.     

Radiological follow-up of motion in the cervical spine after surgery]

The influence of cervical spine in motion after surgery was evaluated by preoperative and postoperative functional radiography. Based on the analysis of postoperative radiograms, the following results were obtained: (1) The motion of cervical spine segments adjacent to the level of the anterior interbody fusion was increased after surgery. The larger the number of fused vertebral bodies, the greater the motion of the adjacent segments. A larger number of anterior fused vertebral bodies may cause more future damage to adjacent intervertebral discs. (2) The motion of the cervical spine was decreased after posterior procedures, especially laminoplasty, which preserves the posterior element. (3) Tilting motion and lordosis of the C 1/2 level was increased after anterior interbody fusion, laminectomy and laminoplasty.     

颈椎前路手术后吞咽困难的原因分析

目的：探讨颈椎前路手术后发生吞咽困难的相关因素。方法：随访2002年10月～2004年10月间颈椎前路手术患者490例。其巾男306例，女184例；年龄12～76岁，平均47．2岁；诊断为颈椎病415例，颈椎骨折脱位43例．颈椎间盘突出症22例，颈椎椎体肿瘤8例．颈椎结核2例。观察患者手术后是否存在吞咽困难；对于存在吞咽困难的患者均静脉应用地塞米松及对症治疗。结果：共有96例（19．6％）患者出现不同程度吞咽困难，持续时间3周～24个月。男42例，女54例，年龄38～63岁，平均57．6岁。96例吞咽困难患者巾，使用钛板内同定89例．使用颈椎椎间融合器7例：颈椎融合术未加内固定者及颈椎人工间盘置换者均未出现吞咽困难病例。女性、高龄及使用钛板内植物等因素与吞咽困难之间存在相关性。96例患者平均随访14．2个月，90例（93．7％）吞咽困难的症状消失或减轻，6例（6.3％）症状无改善。结论：吞咽困难是颈椎前路手术后常见的并发症；其发生可能与多种因素有关。临床医生应给予相应重视和采取相应措施以减少其发生。     

Comparison of anterior cervical fusion after two-level discectomy or single-level corpectomy: sagittal alignment,cervical lordosis,graft collapse,and adjacent-level ossification

Background contextSingle-level corpectomy and two-level discectomy with anterior cervical plating have been reported to have comparable fusion and complication rates. However, there are few large series that have compared the two for sagittal alignment, cervical lordosis, graft subsidence, and adjacent-level ossification.PurposeTo determine the differences between these two procedures for patients with two-level spondylosis by comparing the pre- and postoperative radiographic data.Study designRetrospective review of prospectively collected data in an academic institution.Patient sampleFifty-two with a single-level corpectomy and 45 with a two-level anterior cervical discectomy and fusion (ACDF).Outcome measuresPre- and postoperative radiographic data for sagittal alignment, cervical lordosis, subsidence, and adjacent-level ossification.MethodsWe retrospectively reviewed the lateral cervical radiographs of patients who had a solid fusion after a single-level cervical corpectomy or a two-level ACDF for the treatment of a degenerative cervical spondylosis by a surgeon at an academic institution. The choice of the operation was dependent on the presence or absence of retrovertebral compression. All patients underwent anterior cervical fusion using fibula strut allograft and variable-angle screw-plate fixation. None had had prior cervical spine surgery. Twenty-five were excluded because of inadequate radiographs and follow-up. There were 52 with a single-level corpectomy and 45 with a two-level ACDF. The following were analyzed: 1) sagittal alignment (modified method of Toyama); 2) cervical lordosis measured by Cobb angles of fusion constructs (fusion Cobb) and C2–C7 (C2–C7 Cobb); 3) graft collapse determined by the subsidence of anterior/posterior body height of fused segments (anterior/posterior subsidence) and the cranial/caudal plate-to-disc distances (cranial/caudal subsidence), and the difference between anterior and posterior body height for the fused levels (anteroposterior [AP] difference); and 4) the severity of ossification at two adjacent levels.ResultsThe mean durations of follow-up were 23.3±6.6 (corpectomy) and 25.7±6.2 (ACDF) months, range 12 to 45 months. There were no significant differences between the two groups in sagittal alignment, cervical lordosis, graft collapse, and adjacent-level ossification. Graft subsidence and loss of cervical lordosis occurred significantly more during the first 6 weeks after surgery (all measurements, p<.0001) than after 6 weeks, with no significant difference between the two groups. Posterior and caudal end plate subsidence significantly progressed after 6 weeks in Group 1 (p=.04, p=.02). The final follow-up Cobb angle positively correlated with preoperative and immediate postoperative Cobb angles (r=0.437, p<.0001; r=0.727, p<.0001), caudal subsidence (r=0.270, p=.008), and the final AP difference (r=0.915, p<.0001) but did not correlate with surgery level, preoperative and final sagittal alignments, anterior/posterior subsidence, and cranial subsidence. Anterior/posterior subsidence was significantly more strongly related with caudal subsidence (r=0.607, p<.0001; r=0.424, p<.0001) than cranial (r=0.277, p=.007; r=0.211, p=.040) but did not correlate with pre- and postoperative fusion Cobb, and preoperative and the last sagittal alignments.ConclusionsOur data suggest that the two procedures yield comparable results in terms of sagittal alignment, cervical lordosis, graft subsidence, and adjacent-level ossification. Graft subsidence and loss of cervical lordosis appeared to occur mainly during the first 6 weeks after surgery. Single-level corpectomy and fusion continued to subside at the posterior portion of caudal end plate even after 6 weeks. On the other hand, graft subsidence did not correlate with preoperative and final postoperative sagittal alignments.     

寰枢椎脱位翻修手术的临床疗效观察

目的 :探讨一期前路经口咽松解并后路复位固定融合术对寰枢椎脱位手术治疗失败病例翻修的手术要点及疗效。方法:2001年10月~2011年10月对29例寰枢椎脱位手术治疗失败病例行翻修手术,其中26例获得随访,男12例,女14例。初次手术时年龄4~56岁,平均33.5岁,齿状突骨折不愈合6例,齿状突发育畸形6例,横韧带断裂2例,先天性寰枕融合12例。翻修手术时年龄12~60岁,平均37.2岁。两次手术相隔11~158个月,平均44.2个月。8例初次手术后未复位,18例复位后因内固定失败再次脱位,脑干脊髓角平均101.8°。患者均有枕颈部持续性疼痛,其中19例伴脊髓神经功能障碍,JOA评分平均8.5分。均行一期前路经口咽松解、后路复位减压、寰枢椎或枕颈固定融合术,其中12例行C1-C2融合,6例C0-C2融合,3例C0-C3融合,3例C0-C4融合,2例C1-C4融合。随访患者临床疗效并进行影像学评估。结果:手术均顺利完成,手术时间210~340min,平均290min;失血量500~1100ml,平均700ml。术中未发生血管、神经和脊髓等损伤,术后无咽壁和椎管内感染发生。19例(73.1%)获得完全复位,7例不完全复位;脑干脊髓角恢复至平均143.0°,其中11例达到正常,15例小于正常。随访18～90个月,平均45个月,随访期间未见内固定松动表现,植骨均获得骨性融合;临床症状明显改善,19例伴有脊髓神经功能障碍患者末次随访时JOA评分平均12.6分。按Macnab疗效评估标准评定:优10例,良6例,无改善3例。结论:一期前路经口咽松解、后路复位减压、寰枢或枕颈固定融合术是一种具有较好临床疗效的寰枢椎脱位翻修术式。     

颈前路手术早期并发症的防治

目的总结分析颈椎前路手术早期并发症，探讨其防治策略。方法1998年11月-2006年12月，采用前路手术治疗颈椎疾患363例，其中男268例，女95例；年龄17～79岁，中位年龄50．6岁。颈椎病224例，颈椎间盘突出症39例，颈椎外伤87例，颈椎肿瘤9例，颈椎结核4例。采用前路减压、自体髂骨融合治疗48例，前路减压、植骨融合联合带锁钢板内固定132例，前路减压、钛网植入联合带锁钢板内固定183例。结果术后282例获随访3个月～5年，平均1年11个月。手术相关并发症23例，发生率为8．16％。喉上神经损伤3例，经禁流质饮食及补液治疗，术后3～7d症状消失；喉返神经损伤2例，行发音训练，3个月后恢复正常；脊髓损伤1例，经抗炎脱水治疗，下肢肌力6个月后恢复至术前水平；硬脊膜撕裂2例，经皮肤肌肉严密缝合，切口适度加压包扎后愈合；内固定相关并发症10例，其中1例螺钉拔出，因吞咽困难行再次手术，余行对症治疗、头颈胸石膏固定，3～18个月后固定节段融合：颈部血肿形成4例，其中1例因抢救方法不当死亡；植骨区及创口感染1例。结论充分的术前准备、熟悉颈前路解剖以及严格规范化操作，是预防颈椎前路手术早期并发症的关键。     

选择性融合术治疗老年人颈椎过伸性损伤

目的探讨选择性融合治疗合并多节段退变的颈椎过伸性损伤的手术疗效。方法对2002~2006年收治的16例颈椎过伸性损伤根据临床表现实施单节段椎间隙减压,植骨融合内固定术,术后予以脱水、抗感染等对症治疗。结果所有患者随访均获得了骨性融合,神经功能障碍按JOA评分由术前14~16(平均15.2±1.3)分改善至术后16~17(平均16.7±0.6)分。结论选择性融合治疗多节段退变的颈椎过伸性损伤是一种简单、安全的手术治疗方法,可以减少患者的创伤,最大程度地保留患者颈椎运动功能。