内窥镜下颈椎前路减压植骨融合术的初步报告

目的 探讨内窥镜下颈椎前路减压植骨融合技术的可行性、临床手术技巧及疗效。方法 颈椎骨折脱位7例及颈椎间盘突出症16例，男14例，女9例；年龄23～64岁，平均41.5岁。在全麻下取右颈前偏外侧横切口（长1.6cm)，通过工作通道，在电视监控下切除颈椎间盘，扩大椎间隙。颈椎骨折脱位者采用颈前路钛钢板固定5例、高分子聚合材料GBK颈椎Cage固定1例，螺纹状钛合金Cage固定1例；颈椎间盘突出症者采用颈前路钛钢板固定2例，高分子聚合材料GBK颈椎Cage固定12例，螺纹状钛合金Cage固定2例。结果 全部病例随访6～18个月，平均12.2个月。手术切口均一期愈合，无一例发生内固定松动，椎间骨融合率100%。颈椎骨折脱位伴不全瘫或全瘫患者疗效评估采用Frankel分级标准；2例全瘫者术后分级无变化；3例不全瘫者术前均为C级，术后半年随访时2例恢复到D级，1例恢复到E级。颈椎间盘突出症患者的疗效分析采用Odom评估标准；优10例、良5例、可1例，优良率为94%。结论 通过对椎间盘手术设备和技术的改进，可将其用于颈椎前路减压植骨融合内固定术。术后短期随访效果满意。

Preliminary report of anterior cervical discectomy and interbody fusion by endoscope

Objective To explore the technical feasibility and effects of ant erior cervical discectomy and interbody fusion using endoscopic technique. Metho ds A retrospective study was undertaken in 23 patients with single segmental cer vical fracture and dislocation or cervical spondylotic myelopathy. There were 14 males and 9 females with an average age of 41.5 years (range, 23 to 64). The fr acture and dislocation patients consisted of 2 cases with complete tetraplegia e ither of C3,4 or C4,5, 3 with incomplete tetraplegia of C5,6 and 2 of C4,5 free from nervous symptoms. The operative procedures included anterior cervical disce ctomy and interbody fusion with insertion of cage or/and plate fixation through an endoscopic working canal. Results All 23 cases were followed-up from 6 to 18 months. The operative incisions healed smoothly. All patients achieved interbody fusion, and no loosening or displacement of the cage and plate occurred. For th e cervical fracture and dislocation patients, by Frankel's classification, 2 cas es with complete tetraplegia showed no any improvement, 2 cases with incomplete tetraplegia improved from grade C preoperatively to grade D postoperatively, 1 c ase with incomplete tetraplegia upgrade from C to E, 2 cases without nervous sym ptoms maintained preoperative status. For cervical spondylotic myelopathy patien ts, according to Odom's scoring system, 10 cases were assessed as excellent (dis appearance of all symptoms), 5 good (alleviation of main symptoms), 1 fair (alle viation of partial symptoms). 94% patients gained excellent and good results. No complications occurred in this series. Conclusion With the improvement of the t echnique and instrument, the endoscopic procedures can be used for anterior cerv ical discectomy, interbody fusion and internal fixation. It presents microsurgic al advantages such as minimal incision, less traumatic reaction, clear intraoper ative visualization, and less postoperative discomfort comparing to traditional approach.