起重式拉钩辅助下颈椎管前路扩大减压术

目的 探讨起重式拉钩辅助下颈椎管前路扩大减压术的适应证、方法及其临床效果.方法 患者37例,男21例,女16例;年龄42～69岁,平均年龄57岁.术前影像学检查结果示后纵韧带骨化物17例和椎间盘突出20例,术前神经功能评分JOA6～15分,平均12.3分.行颈前路常规手术入路,椎体开槽切骨达椎体后壁,范围超过病灶.在椎体后壁上下缘和术侧缘三边开槽,利用起重式拉钩插入椎体后壁下,缓慢钩起椎体后壁及致压物,直视下用超薄型枪状咬骨钳切除椎体后壁及致压物,而后植骨固定,恢复颈椎稳定性.结果 随访3～24个月,平均13个月.术后评分JOA10～16分,平均15.6分,其中疗效优18例,良15例,可4例,优良率89.19％.结论 起重式拉钩应用降低了颈椎管前路单开门扩大减压术的难度,提高了手术的安全性和疗效.

Anterior enlarging cervical vertebral canal decompression assisted with lift-hook

【Objective】To study the indications,methods and clinical results of anterior enlarging cervical vertebral canal decompression assisted with lift-hook.【Methods】Thirty seven patients were treated with anterior cervical vertebral canal decompression.This included 21 males and 16 females,with the mean age of 57 years(ranged from 42 to 69 years).There were ossifications of the posterior longitudinal ligament or intervertebral disk hernia observed in the preoperative radiological expression of all the cases.The mean preoperative neurological JOA scores were 12.3 points(ranged 6～15 points).The cervical spine was exposed through a standard anterior approach,and the vertebral bodies were partially removed using an appropriate reamer until posterior wall of the cervical vertebrae was fully exposed.The scope of vertebral resection was larger than that of the ossification.Remove the posterior wall surrounding ossification at upper side and lower side and operated side.Then the posterior wall of cervical vertebrae was grooved slowly and separated from the underlying spinal dura mater with the assistance of the lift-hook designed by our-selves.After that,the ligament and posterior wall was slightly lifted and removed by Kerrison ultrathin-rongeurs.Finally,bone grafting and internal fixation with plate were performed across the segments to restore the stability of the cervical spine.【Results】All cases were followed up,and the time was from 3 months to 24 months,with average time of 13 months.The mean postoperative JOA scores were 15.6 points(range 10～16 points).Of them,the clinical results were excellent in 18 patients,good in 15,fair in 4,resulting in 89.19% of excellent and good rate.【Conclusion】The application of lift-hook in anterior cervical spinal decompression can cut down the difficulty of operation and made this procedure safer and more effective.