摘要
目的探讨前路跳跃性椎体次全切、分节段减压植骨融合术治疗多节段脊髓型颈椎病及后纵韧带骨化症的疗效。方法15例多节段（≥3个节段）脊髓型颈椎病或后纵韧带骨化症患者均接受前路跳跃性椎体次全切除减压＋自体髂骨或钛网植骨融合＋前路钢板固定术。男9例，女6例；年龄51-80岁，平均56岁。术中对C4、C6椎体行次全切，在保留C，椎体基础上切除其后缘增生骨赘、突出的椎间盘和（或）骨化的后纵韧带，在C3-5和C5-7。进行结构性植骨，以c，椎体为中间固定椎体行颈前路钢板内固定。术后采用日本骨科协会（Japanese Orthopaedic Association，JOA）评分系统评估神经功能恢复情况：摄X线片和三维CT重建评估融合程度；同时行MR检查，以观察脊髓减压程度和脊髓情况。结果所有患者均获得9-42个月随访，平均26．7个月。15例患者均达到骨性融合。JOA评分由术前平均（13．44±2．81）分改善至术后（16．16±2．19）分。颈椎序列由术前1．16°±11．74°改善至术后即刻14．36°±7．85°，末次随访时为12．92°±6．17°。术后声嘶2例，吞咽困难1例。结论前路选择性椎体次全切除结合分节段减压植骨融合术治疗多节段脊髓型颈椎病及后纵韧带骨化症疗效可靠。保留C5椎体提供了额外的把持力、增加了结构的稳定性，避免跨多节段植骨内固定而导致的内固定失败。
Objective To evaluate effect of combined eorpectomy for multilevel cervical spondylotie myelopathy （CSM） and ossified posterior longitudinal ligament （OPLL）. Methods Fifteen patients with CSM or OPLL, including 9 males and 6 females, were treated with combined eorpectomy which is characterized by C4 and C6 eorpeetomy, excision of osteophyma, protruded disc and/or ossified posterior longitudinal ligament on basis of preservation of C5 vertebral body, structural bone grafting in C3-5 and C5-7, and anterior cervical plate fixation at C3, C5, and C7： The clinical results were evaluated with Japanese Orthopaedic Association （JOA） score. X-rays and CT scans were taken to evaluate vertebral fusion, and MRI was used to access spinal canal decompression and condition of spinal cord. Results All patients were followed up for 9 to 42 months （average, 26.7 months）. Bony fusion was achieved in all 15 patients. The JOA score improved from preoperative 13.44±2.81 to postoperative 16.16±2.19 （P=0.0354）. The cervical lordosis improved from preoperative 1.16°±11.74° to immediately postoperative 14.36°±7.85° （P=0.00217）, and 12.92°±6.17° at the final follow-up （P=0.00292）. The complications included temporary hoarseness in 2 cases, dysphagia in 1 case. Conclusion The combined corpectomy for treating CSM and OPLL can obtain reliable and satisfactory re- sulks. In operation, the preservation of C5 vertebral body can provide an additional screw anchoring force and strengthen stability.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2012年第8期721-725,共5页
Chinese Journal of Orthopaedics
关键词
颈椎病
骨化
后纵韧带
脊髓压迫症
脊柱融合术
Cervical spondylosis
Ossification of posterior longitudinal ligament
Spinal cord compression
Spinal fusion
