椎间撑开前路减压植骨钢板内固定治疗脊髓型颈椎病

目的探讨脊髓型颈椎病行椎间撑开前路减压植骨钢板内固定的疗效。方法选择2004-01～2008-06收治的36例脊髓型颈椎病，其中单节段病变30例，两节节段病变6例，都有不同程度的脊髓神经损伤。所有患者进行椎间撑开前路矩形减压植骨钢板内固定术，比较术前术后病变椎间隙高度和脊髓功能，采用日本骨科学会（JOA）的评分标准对疗效进行评价。结果36例获得随访6—12个月，平均9个月，无颈髓和喉上喉返神经损伤，无钢板和螺钉松动及椎前血肿等并发症发生。术前与术后、术前与术后6个月以及术后与术后6个月的JOA评分及椎间隙高度比较差异均有统计学意义（P均〈0．01）。术后6个月明显改善脊髓神经功能，基本维持椎间隙高度和颈椎生理曲度。结论椎间撑开前路矩形减压植骨钢板手术减压较彻底，能有效维持椎间高度和稳固固定，减少邻近椎体退变，是目前两节段以内脊髓型颈椎病较常用、疗效可靠的治疗方法。

Interbody distraction and anterior cervical decompression and bone graft and plate fixation in the treatment of cervical spondylotic myelopathy

Objective To study the methods and effects of cervical spondylotic myelopathy （CSM） treated by interbody distraction, anterior decompression, bone graft and plate fixation. Methods From January 2004 to June 2008 a total of 36 cases of cervical spondylotic myelopathy were treated, in which a single segmental lesions occurred in 30 cases, the two segmental lesions in 6 cases, with varying degrees of spinal cord nerve injury. All patients were treated by anterior interbody distraction decompression and bone graft rectangular plate fixation. The preoperative and postoperative diseased vertebral height and spinal cord function were compared, the therapeutic effects were evaluated by the Japanese Orthopedic Association （JOA） score standards. Results Thirty-six cases were followed up for 6 to 12 months, with an average of 9 months, there were not the injury of cervical spinal cord and the superior recurrent laryngeal nerve, loosening of plate and screw and complications such as anterior hematoma. There were significant difference in scores of JOA and the intervertebral space between preoperation and postoperation, six month of postoperation, postoperation and the six month of postoperation （ P 〈 0. 01 ）. The spinal cord nerve function improved significantly, and the intervertebral space height and cervical physiological curvature were basically maintained 6 months after operation. Conclusion Interbody distraction and anterior cervical rectangular decompression and bone graft and plate fixation is a common and reliable method in the treatment of cervical spondylotic myelopathy within two segments. It can thoroughly reduce pressure and effectively intervertebral space height and firmly fix vertebral body and reduce the degeneration of adjacent vertebral body.