前路选择性椎体切除分节段减压植骨融合术治疗多节段脊髓型颈椎病

目的 回颐性分析多节段脊髓型颈椎病前路选择性椎体次全切除分节段减压植骨融合术的疗效,并评估其相关影响因素.方法 25例多节段(≥3个节段)脊髓型颈椎病患者,均接受前路选择性椎体次全切除+分节段颈椎间盘切除减压+自体髂骨或钛网植骨融合+前路钢板固定术.男14例,女11例;年龄49～77岁,平均52岁.在病变严重部位行椎体次全切除+钛网或髂骨块植骨,其余部位则仅行椎间盘切除减压钛网或自体髂骨植骨术;均结合应用前路钢板多组螺钉(≥3组)固定.术后测量颈椎矢状面的活动度(range of motion,ROM);采用日本矫形外科学会(Japanese Orthopaedic Association,JOA)评估系统评估其功能恢复情况;采用正侧位、动力位X线片和三维CT重建方法评估融合程度;同时进行MR检查,以观察脊髓减压程度和脊髓情况.结果 所有病例均获得平均35.2(12～70)个月的有效随访.JOA评分:术前为9.5±1.3,术后6个月为13.8±0.8,与术前比较差异有统计学意义(P＜0.05),末次随访为13.6±0.9,与术后6个月比较差异无统计学意义(P＞0.05).术后12个月和末次随访,所有病例均已达到骨性融合,且椎管减压明显.术前ROM为68.1°±2.5°,术后6个月则为45.6°±3.5°,二者间差异有统计学意义(P＜0.05);末次随访时为50.0°±3.2°,与术前比较差异有统计学意义(P＜0.05).结论 前路选择性椎体次全切除结合分节段减压植骨融合术治疗多节段脊髓型颈椎病效果可靠;因为并没有全部切除所有节段的椎体,并结合应用多组螺钉固定钢板,所以初始稳定性较强,避免因为跨多节段植骨内固定而导致的内置物失败.

Clinical results of selective anterior corpectomy combined with segmental discectomy and fusion for multilevel cervical myelopathy

Objective To ev aluate clinical results of selective anterior corpectomy combined with segmental discectomv and fusion for multilevel cervical myelopathv andits related factors.Methods Twenty-five patients of multilevel cervical myelopathv with 3 or 4 consecutive segments were treated with selective anterior corpectomy combinedwith segmental discectomy and fusion.The clinical results were evaluated by the parameters including improvement of Japanese Orthopaedic Association (JOA)score postoperatively,fusion rate,and the degree of spinal canal decompression and range of motion of the cervical spine.Results JOA score were improved from 9.5±1.3 pre-operatively to 13.8±0.8(P＜0.01)6 months post operation and 1 3.6±0.9(P＜0.05)atthe final follow-up.Bony fusion was verified by X-ray and 3D-CT scan 1 2 months post operation and final follow-up.Moreover,the degree of decompression of the spinal canal was also remarkable.The range of motion of the cervical spine after operation decreased significantly(P＜0.05).Conclusion Selective anterior corpectomy combined with segmental discectomy and fusion was an alternative choice for the surgical treatment of multilevel cervical myelopathy.