椎动脉型颈椎病手术方式选择

目的探讨不同病因的椎动脉型颈椎病手术技巧和手术方式的选择以及术中椎动脉的保护。方法61例椎动脉型颈椎病患者均行CT、核磁共振成像(MRI)、核磁共振血管成像(MRA)检查。根据不同病因及椎动脉受累的影像学特点选用了7种手术方式治疗。其中横突孔切开椎动脉减压术7例,钩椎关节切除减压术8例,钩椎关节切除及横突孔切开椎动脉减压术8例,椎间隙植骨融合术9例,钩椎关节切除及椎间孔扩大术12例,前路减压及钩椎关节切除、植骨融合术10例,横突孔切开、钩椎关节切除、颈椎椎体次全切除术7例。结果全部患者手术经过顺利,疗效满意,总优良率为93.4%。术中误伤2例各1支椎动脉,分别行缝扎及骨块外包明胶海绵填塞压迫止血,未见明显椎动脉缺血症状。结论椎动脉型颈椎病手术难度大,技术要求高,术前应准备必须的显微器械,掌握手术技巧,对不同病因的椎动脉型颈椎病应选择不同的手术方式。

Surgery for vertebral artery type of cervical spondylosis

Objective To discuss the protection of vertebral artery in different operative methods for cervical spondylosis involving the vertebral artery. Methods Sixty-one cases of cervical spondylosis involving the vertebral artery were operated by seven operative methods according to the vertebral artery imaging of CT, MRI and MRA. Transverse foramens were decompressed in 7 cases, luschka joints were excised in 8 cases, transverse foramens decompression combined with luschka joints excision were performed in 8 cases, fusion with bone graft were in 9 cases, both luschka joints excision and vertebral foramen decompression were in 12 cases, anterior decompression and luschka joints excision were in 10 cases, transverse foramens decompression, luschka joints excise and subtotal vertebrae resection were only in 7 cases. Result All the operative results were satisfied,and the excellent rate was 93.4%. Conclusion The satisfied results are due to the selection of appropriate method.