摘要
目的应用手术治疗退行性颈椎不稳,观察其疗效,并探讨手术适应证。方法自1998年4月～2001年4月,对15例影像学上有颈椎不稳、伴体位性症状、经1年以上严格保守治疗无效的非脊髓型颈椎病患者施行手术治疗。男6例,女9例;年龄44～65岁,平均55.2岁。病程1.5～4年,平均28个月。体位性症状主要包括:随颈椎屈伸或旋转出现的神经根型、交感型以及椎动脉型颈椎病样症状。所有病例均采取前路颈椎不稳节段融合加钛板内固定术。自体髂骨植骨7例,其中单节段3例;双节段4例,双节段者行开槽植骨。应用椎间融合器(钛网)8例,其中单节段2例,植骨取自异体骨;双节段6例,行开槽植骨,植骨取自椎体切除部分。结果随访时间8个月～4年,平均25个月。15例患者症状均获明显改善,12例症状完全消失,3例偶有颈背部酸胀感。融合节段均获得骨性愈合。结论影像学上出现退行性颈椎不稳同时伴有颈椎体位性症状,且两者可相互解释者,通过行不稳节段的融合术可获得良好的治疗效果。退行性颈椎不稳有良性转归的可能,因此应严格掌握手术适应证。
Objective Cervical instability was mostly caused by trauma. However, degenerative cervical instability was diagnosed rarely according to the present criteria although cervical degeneration was common in aged people. The study was aimed at investigating the results of surgical treatment for degenerative cervical instability and to define the indications for surgical intervention. Methods From April 1998 to April 2001, anterior cervical fusion and plate fixation were applied in fifteen patients, there were 6 males and 9 females aged from 44 to 65 years with an average of 55.2 years. The patients showed roentgenographic instability of the cervical spine associating with cervical postural symptoms. Spondylotic cervical myelopathy were excluded from the group. The cervical postural symptoms were those presented or aggravated with flexion-extension or rotational movements of the cervical spine, such as neck-shoulder pain, cervical spondylotic radiculopathy symptoms, sympathetic or vertebral artery symptoms. The symptoms lasted from 18 months to 4 years before the index surgery, all patients had received more than one year conservative treatments, but no any improvement. Seven cases were fused with iliac autograft, in which three cases were on single intervertebral spaces, four cases on double spaces, and grooved bone graft was used in the patient of double space fusion. Intervertebral fusion cage (Titanium mesh) was used in 8 cases; allograft was used in 2 single space cases; grooved autograft was used in 6 double space cases. Excised vertebral body was used as autograft material. Results The patients were followed up from 8 months to 4 years with an average of 25 months. All patients were satisfactory for the surgical results in follow-up period. All symptoms were released in 12 cases, occasional neck pain was found in 3 cases, and there was no abnormality presented in clinical examination. Solid fusion was achieved in all of cases at follow-up, the fused segment was stable judging by dynamic roentgenogram. Conclusion
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2003年第9期554-557,共4页
Chinese Journal of Orthopaedics
