前路跳跃式减压在4节段脊髓型颈椎病临床疗效分析

目的评价前路跳跃式减压植骨融合术治疗4节段脊髓型颈椎病的临床疗效。方法对16例4节段脊髓型颈椎病患者采用跳跃式减压，保留颈5椎体，切除颈4、6椎体的分节段减压。分析手术时间、术中出血量、术后6个月植骨融合率、JOA评分改善率，节段性前突角度。结果所有患者均获随访，平均18个月。手术时间130～260min，平均180min；术中失血约300～800ml，平均650ml；术后颈椎X—RAY提示均恢复颈椎生理曲度，及椎间高度；6个月植骨融合率93．75％。无植骨块脱m或钛笼下沉、钢板螺钉断裂松脱、脑脊液瘘及感染等严重并发症发生。术后3、6个月及术后1年JOA评分为（13．6±1．3）、（13．9±1．1）、（14．O±0．8）分（P〈0．05），术后3、6个月平均改善率为56．4％、60．2％、61．5％。节段性前突角度术前（9．38＋3．0），术后（16．22＋1．9）。（P〈0．05）。结论颈椎前路跳跃式减压植骨融合术治疗四节段脊髓型颈椎病是较好的手术方式，具有更多优点。

Analysis of the clinical efficacy of skip corpectomy in the treatment of four segmental cervi- cal spondylotic myelopathy

Objective To evaluate the clinical effects of skip eorpeetomy in the treatment of four segmental cervical spondylotic myelopathy. Methods 16 patients with four segmental cervical myelopathy were treated with skip corpectomy and fusion, 16 patients four segments underwent C-4 and C-6 corpectomy,C-5 osteophytectomy,and C-5 vertebral body preservation. The operation time,blood loss,graft or implants fusion rate and improvement of JOA score postoperative 6 months,segmental lordosis postoperatively were analyzed. Results All the patients were followed up for average 18 months. The operation time was 130-260 min,average 180 rain. The blood loss was 300-800 ml with an average of 650ml. Intervertebral heights and physiologic curves were kept well and there were no plate/screw break or loose. 6 months after operation,the graft or implants fusion rate was 93.75%,with no bone graft dislocation and cage subsidenee,cerebrospinal fluid leakage and infection complications. The JOA scores of postoperative 3 months,6 months,1 year were（13.6＋ 1.3）,（13.9＋l.1）,（14.0＋0.8）（P〈0.05）,and the JOA score improvement rates were 56.4%,60.2%, 61.5%. The segmental lordosis was （9.38＋3.0）~preoperatively,and that was （16.22＋l.9）%postopera- tively（P〈0.05）. Conclusion Skip eoipectomy is a recommendable technique for four segmental cer- vical spondylotie myelopathy.