颈椎后前联合手术入路治疗脊髓型颈椎病

目的:探讨后前联合手术入路Ⅰ期或分期治疗脊髓型颈椎病的疗效.方法:2001年6月至2008年10月应用Ⅰ期或分期后前联合入路治疗脊髓夹持型颈椎病及合并发育性颈椎管狭窄颈椎病45例,男35例,女10例;年龄45～72岁,平均53岁.均先后路再前路,Ⅰ期联合5例,分期联合40例.均后路单开门椎管成形,前路减压植骨后均行钛板固定.术后3个月、1年采用JOA评分对其进行疗效评定.结果:44例获随访,时间13～62个月,平均30个月;1例术后21 d死于肺部感染.C5神经麻痹3例,发音嘶哑1例,轴性症状14例,髂骨供区并发症2例.钛板螺钉均无断裂、退出,无骨块、钛网移位及沉陷,无"再关门"及颈椎畸形发生.44例前路植骨及后方门轴均获骨性愈合.按JOA评分标准:术前平均(9.36±2.24)分,术后3个月平均(12.34±2.64)分,术后1年平均(12.77±2.61)分;术后3个月、1年与术前比较差异均有统计学意义.44例中,优16例,良19例,好转6例,无效3例.结论:后前联合手术是治疗脊髓夹持型颈椎病及合并发育性颈椎管狭窄颈椎病的安全有效方法,应依据患者及手术条件选择一期或分期联合,前路钛板固定可有效恢复颈椎生理曲度、椎间高度及预防植骨并发症.

Combined posterior and anterior approaches for the treatment of cervical spondylotic myelopathy

Objective: To explore the efficacy of one stage or staging treatment of cervical spondylotic myelopathy through combined posterior and anterior approaches. Methods: From June 2001 to October 2008,45 patients with pinching cervical spondyoltic myelopathy and developmental stenosis of cervical spinal canal were decompressed through combined posterior and anterior approaches in one stage or staging operation. Among the patients,35 patients were male and 10 patients were female,ranging in age from 45 to 72 years,with an average of 53 years. Five patients were decompressed through combined posterior and anterior approaches in one-stage operation,and other 40 patients were treated in staging operation. All the patients were treated with open-door posterior cervical expansive laminoplasty and anterior decompression,bone graft and titanium plate internal fixation. JOA scores were used to evaluate the therapeutic effects at the 3rd month and one year after operation. Results: After the treatment,44 patients were followed up from 13 to 62 months,with an average of 30 months. One patient was dead of lung infection at the 21th day after operation. The nerve root palsy of C5 was found in 3 cases. One patient had postoperative hoarseness. Axial symptoms were found in 14 cases. Two patients had donor site complications. There were no screws broken or back out,no screw loosening,no moving or sinking of bone block or Ti-net,no door re-closer and cervical deformity. Forty-four patients got spinal fusion. According to JOA score criteria:the average preoperative JOA score was(9.36±2.24)points,JOA score was(12.34±2.64)points in 3 months after operation,(12.77±2.61)points in one year after operation. Among 44 cases,16 got an excellent result,19 good,6 fair,3 invalid. There were statistically differences between preoperative score and 3 months or one year after operation. Conclusion: Decompression through combined posterior and anterior approaches for the treatment of pinching cervical spondyoltic myelopathy and developmental stenosis of cervical spinal canal has good efficacy,as well as a safety operation method. The operation method with one or staging decompression through combined anterior and posterior approach should be chosen according to the conditions of the patients and the operations. Anterior decompression,bone graft and titanium plate internal fixation could restore the height of vertebral body effectively and prevent fusion complication.