多节段颈椎病前路减压植骨内固定临床效果评价

[目的]探讨多节段颈椎病前路减压植骨内固定术的方法和疗效.[方法] 2008年4月～2011年5月,采用颈前路减压植骨融合术治疗46例多节段颈椎病.男32例,女14例；年龄49～73岁,平均58岁,均为连续3个节段病变,其中C3、4、C4、5、C5、6 30例,C4、5、C5、6、C6、7 16例.46例均有不同程度四肢与躯干感觉减退,双手握力减弱,双下肢行走不稳及腱反射亢进.颈椎MRI示均有3个节段椎间盘退变、突出,相应节段脊髓受压.病程7～ 29个月,平均13.5个月.将日本骨科协会(JOA)评分系统作为疗效评价标准,记录患者术前及术后1周,3、12个月JOA评分并计算改善率.[结果]术后切口均Ⅰ期愈合.无椎动脉损伤及喉返神经损伤发生.46例均莸随访,随访时间12～24个月,平均15.1个月.术后2周内患者神经症状明显好转,下肢肌力增加,肢体活动较术前明显改善,且双上肢感觉异常基本消失.内固定物位置均良好.46例术后12个月颈椎正侧位X线片均可见椎间隙融合,椎间高度及生理弧度维持良好.JOA评分由术前(8.1±0.3)分提高至术后12个月(14.6±0.4)分,比较差异有统计学意义(P＜0.05)；术后12个月时改善率为(69.8％±0.2％).颈部功能障碍指数(NDI)由术前(19.0％±3.4％)降低到末次随访时的(7.8％±2.2％),颈椎融合节段前凸Cobb角由术前的(8.8°±1.2°)增加到术后的(18.0°±2.5°),比较差异有统计学意义(P＜0.05).按照Odom临床效果分级标准评价:获优20例,良17例,可8例,差1例、[结论]颈前路减压植骨融合术可达到充分减压,即刻重建颈椎生理曲度及稳定性,植骨融合率高,是治疗多节段颈椎病的有效方法之一.

Treatment of multi-level cervical spondylosis by anterior decompression and autograft fusion with introfixation

[Objective]To evaluate the clinical effects of anterior decompression and autograft fusion with internal-fixation in treating multi-level cervical spondylosis.[Methods]Between April 2008 and May 2011,46 patients with multi-level cervical spondylosis were treated with anterior decompression,autograft fusion,and internal fixation.There were 32males and 14 females with an average age of 58 years(range,49-73 years).Consecutive 3 segments of C3、4,C4、5,and C5、6 involved in 30 cases and C4、5,C5、6,and C6、7 in 16 cases.All patients suffered sensory dysfunction in limbs and trunk,hyperactivity of tendon reflexes of both lower extremities,walking with limp,and weakening of hand grip.Cervical MRI showed degeneration and protrusion of intervertebral disc and compression of cervical cord.The disease duration were 7 to 29 months(13.5 months on avera-ge).Japanese Orthopedic Association(JOA) score system was adopted for therapeutic efficacy evaluation.JOA scores were recorded preoperatively,1 week,3 months,and 12 months postoperatively.[Results]No cerebrospinal fluid leakage was observed after operation.All the incisions healed by first intention.All cases were followed up for 12 to 24 months.No injury or recurrent laryngeal nerve injury occurred.The nervous symptoms in all cases were improved significantly within 1 week after operation.Lower limb muscle strength increased,upper limb abnormal sensation disappeared,and limb moved more agile.The internal fixator was in appropriate situation,and the fusion rate were 100%.The JOA score increased from 8.1 ±0.3 preoperatively to 14.6± 0.4 at 12 months postoperatively with an improvement rate of 69.8% ± 0.2%,showing significant difference(P<0.05).NDI at final follow up(7.8%±2.2%) was significant lower than preoperative(19.0%±3.4%)(P<0.05).Radiograph analysis indicated that the average angle of lordosis was corrected from 8.8°±1.2° preoperatively to(18.0°±2.5°) at final follow up(P<0.05).According to Odom evaluation scale,the results were excellent in 20 cases,good in 17 cases,fair in 8 cases,and poor in 1 case.[Conclusion]Anterior decompression and autograft fusion is a recommendable technique for multi-level cervical spondylosis,which can make full decompression,conserve the stability of cervical cord,construct the cervical lordosis,and has high fusion rate.