环锯法颈椎前路减压二十年

环锯法颈椎前路减压报道后已二十年余，我院已施行数千例次，并已推广到各兄弟院校，但有些小问题会使手术失误，有人不敢应用，在此敬将二十年来使用中的改进，并说明其改进理由，对环锯法颈椎前路减压容易引起的失误，介绍了其避免的方法，如脊髓损伤或神经根损伤，这是严重失误，但只要环锯钻进时在两侧颈长肌中间，环锯一定要和颈椎垂直，开始旋转环锯前先逆时针方向转几下再顺时针方向加压钻进，记住这三条：“正中”“垂直”“逆时针方向先转几下”。就可避免此失误。在环锯钻取椎间盘骨心时有时半途折断或底部粘连取不出来，其原因和解决办法作了说明。有的患者手术后症状不改善或改善一些后不久又加重，这和术前手术计划，术中操作不确实，或术后处理不当有关系，均作了详细阐述。最后因环锯法椎体上钻孔安全可靠，扩展几项新手术：（1）颈椎前侧方钩椎关节切除椎间孔切开治疗椎动脉型或神经根型颈椎病。（2）颈椎前路开长窗扩大减压治疗颈椎外伤或多节段颈椎病合并颈椎管狭窄，及后纵韧带骨化等。（3）颈椎间盘摘出人工髓核置换治疗脊髓型颈椎病可以节省取髂骨切口，减少手术时间。

Anterior decompression with trepanation on cervical spine for 20 years

Thousands cases of cervical spondylosis were used anterior decompressive trepanation in last 20 years.The operative instruments and techniques were gradually inproved,and described in this paper,It bring the operation more safely easily and excellently.The error of drilling displacement during trepanation can be eliminated by three elements:Trephine may be in the center of the pathogenic disc and long coli muscles;Rigth angle to the cervical spine colum;And turning the trephine in reverse direction of hour hand at first some round.The trepanative technique induced several new operation to improved the decompressive resuluts,they are :Long window decompression treated cervical.spine canal stenosis:Uncoforaminotomy and interbody fusion treated the press on vertebeal artery or nerve root;Replacement prothesis of nucleus proposus after extirpation of pathogenic disc,to save the disc function.