摘要
目的:严重的多节段脊髓型颈椎病单纯前路或后路手术都有其局限性。观察一期前后路联合手术并自体髂骨植骨及带锁钢板内固定材料置入在治疗多节段脊髓型颈椎病中的应用价值。方法:选择2004-11/2006-12本院12例多节段脊髓型颈椎病患者,均采用一期前后路减压、自体髂骨植骨融合、带锁钢板内固定联合手术。其中男9例,女性3例,年龄49～75岁;3节段受累9例,4节段受累3例(突出节段分布:C3～66例,C4～73例,C3～73例)。全部病例进行临床随访,患者均对本试验知情同意。采用mJOA评分标准对患者神经功能改善情况进行评定;术前颈椎侧位片测量,以D值(C4椎体后下缘到齿突后缘与C7椎体后下缘连线的垂直距离)评价颈椎(C2～7)弧度;根据颈椎伸屈动态侧位片C2和C7椎体后缘切线相交所成的夹角之和评价颈椎(C2～7)活动范围。主要以电话随访和问卷填写的方式,分别从神经功能改善情况、颈椎弧度、活动范围及术后并发症等进行随访观察。结果:①12例患者全部得到随访,术后随访时间6～28个月,平均(16±6)个月。②所有植骨均获得骨性愈合;疗效结果中优4例(33.3%);良6例(50%);无效2例(16.7%);颈椎D值术前(3.9±1.4)mm,术后即刻(8.5±1.7)mm,随访时(8.1±2.5)mm。术前与术后差异有显著性(P<0.01),术后与随访时差异无显著性(P=0.251);颈椎活动范围术前(36.3±4.0)°,随访时(10.6±2.7)°,与术前相比差异具有显著性(P<0.01)。③术后C5神经根麻痹1例,为感觉及运动混合型,8个月随访时,感觉功能恢复,肩关节外展肌力从术后Ⅱ级恢复至Ⅳ级;1例术后6个月出现"S"畸形而再次压迫脊髓,神经功能改善停滞,目前处于随访中。结论:一期前后路手术并自体髂骨植骨及带锁钢板内固定材料置入减压充分、彻底,而且前路手术能重建颈椎稳定性,恢复颈椎生理前凸和椎间高度,并且后路减压术又能预防相邻颈椎退变引起的脊髓继发的压迫。
AIM: There are limitations in the anterior or posterior approach for severe multilevel cervical myelopathy (MCM). In this study, the results of anterior-posterior approach in one stage combining with autogenous tricortical iliac crest graft and the anterior locking plate fixation for MCM were evaluated. METHODS: Twelve patients with MCM were selected from November 2004 to December 2006 including 9 males and 3 females, aged 49-75 years. They underwent anterior-posterior decompression in one stage combining with the autogenous tricortical iliac crest graft and the anterior locking plate fixation. There were 9 cases with L3 affected, and 3 cases with L4 affected (distribution of protrution segment: 6 cases of C3-C6, 3 of C4-C7, and 3 of C3-C7). The patients were all followed up by telephone and questionnaire. The improvement of neural function was evaluated by mJOA scales. The cervical vertebra at lateral position was photographed before operation, and D value, the vertical distance from C4 vertebra posterior and inferior border, posterior border of tooth of epistropheus to C7 vertebral posterior and inferior border, was used to evaluate cervical vertebra (C2-C7) radian, and the sum of angles between the posterior border tangents of C2 and C7 in extending and flexion position films was used to evaluated the movement range of cervical vertebra (C2-C7). Meanwhile, the improvement of neural function, cervical vertebra radian, the movement, and postoperative complications were evaluated. RESULTS: ①All patients were followed-up for an average of (16±6) months (range, 6-28 months). ②All grafted bone showed the successful fusion. The postoperative outcomes were excellent in 4 cases (33.3%), good in 6 cases (50%), and failure in 2 cases (16.7%), respectively. Preoperative D values were (3.9±1.4) mm, (8.5±1.7) mm immediately after operation, and (8.1±2.5) mm during follow up. No statistical difference was found before and after operation (P < 0.01), so was that after operation and during follow up (P =0.251). The movement range before operation was (36.3±4.0)°, and (10.6±2.7)° during follow up, which were significantly different compared with that before operation (P < 0.01). ③After operation, there was 1 case with C5 nerve root parlysis, which was the mixed pattern of sense and movement. After 8 months follow up, the sensory function was recovered, and the abductor strength of shoulder joint was improved from degree Ⅱ to degree Ⅳ; at 6 months postoperatively, S deformity was found in 1 case and spinal compression was performed again. The nerve function was not improved. This patient was still under follow up. CONCLUSION: Anterior-posterior approach in one stage combining with the autogenous tricortical iliac crest graft and the anterior locking plate fixation presents full and complete decompression; Meanwhile, it could reconstruct stable cervical vertebra, and recover the physiological lordosis and intervertebral height. Moreover, posterior decompression could prevent spinal secondary compression caused by adjacent cervical degeneration.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第51期10366-10369,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
