脊髓夹持型颈椎病前后路手术的疗效分析

目的分析颈前后路手术治疗脊髓夹持型颈椎病的疗效.方法回顾我院15年来收治脊髓型颈椎病306例,其中脊髓夹持型34例,27例前路减压植骨融合,7例后路椎管扩大,全部病例获得随访.按照JOA评分评定术前和术后神经功能状态.结果前路减压植骨融合27例,优14例,良5例,好转8例,优良率70%.后路椎管扩大7例,优2例,良1例,好转4例,优良率40.3%.结论颈前路减压植骨融合,直接解除脊髓前方的压迫,应作为首选术式.对于多节段(3个节段以上)病变或合并连续型后纵韧带钙化、黄韧带肥厚或合并发育性颈椎管狭窄,仍宜选择后路椎管扩大减压或二期前后路减压术.

Analysis of Cervical Anterior or Posterior Approach Operation Treatment of Pinching Gervical Spondlyoltic Mypelopathy

Objective To analysis effects of cervical anterior of posterior operation to treat pinching cervical spondlylotic myelopathy Method Reviewing 306 cases of cervical spondylotic myelopathy in the past 15 yeares.34 cases of pinching cervical spondylotic myelopating were in this series.27 cases were performed anterior laminectomy to enlarge the spinal canal. All cases were followed up. Ante-operative or Post-operative neural statement of every case was evaluated by criteria of Japanese Orthopedic Association (JOA). Result 27 anterior decompression and fusion with autograft include excellent 14, good 5, better 8, excellent and good rate was 70%,7 posterior laminectomy to enlarge the spinal canal. Include excellent 2, good 1, better 4 excellent and good rate was spinal canal. Include excellent 2, good 1,better 4 excellent and good rate was 40.3%. Conclusion Anterior decompression and fusion with autograft to treat pinching cervical spondylotic myelopathy was direct and effective, It could alleviate the forward press of spinal cord directly it should be the first choice of surgical treatment, posterior approach should be the first choice when the patient was complicated with ligament falvum seriously degeneration, calcification of ossification; more than three segmental pathological changes or complicated with developmental canal stenosis. Otherwise anterior and posterior decompression by stages or one-stage should be performed.