颈前路间盘切除植骨融合钛板内固定和颈后路单开门椎管成形治疗多节段脊髓型颈椎病:重建后的稳定性

发布时间：2018-08-06 20:56

【摘要】：背景:目前多节段脊髓型颈椎病治疗的主要目的是解除脊髓的压迫,最大限度恢复颈椎的稳定性。目的:颈前路间盘切除植骨融合钛板内固定和颈后路单开门椎管成形治疗多节段脊髓型颈椎病的特点分析。方法:67例多节段脊髓型颈椎病患者按照治疗方式的不同分为2组:经颈前路间盘切除植骨融合钛板内固定组和经颈后路单开门椎管成形组。随访12个月观察两组患者颈椎活动度、颈椎曲度指数等颈椎的稳定性变化,进行轴性症状目测类比评分和JOA评分,分别记录手术时间、出血量及不良反应发生率。结果与结论:①两组内固定后均丢失部分颈椎活动度,颈后路单开门椎管成形组颈椎活动度丢失量多于颈前路间盘切除植骨融合钛板内固定组(P0.05);②颈前路间盘切除植骨融合钛板内固定组内固定后颈椎曲度指数较内固定前更接近生理曲度(P0.05),颈后路单开门椎管成形组未见明显改善;③两组轴性症状较治疗前明显缓解(P0.05),颈后路单开门椎管成形组轴性症状缓解不如颈前路间盘切除植骨融合钛板内固定组(P0.05);④两组神经功能比治疗前均得到明显改善(P0.05),组间差异无显著性意义(P0.05);(5)术中出血量颈后路单开门椎管成形组明显多于颈前路间盘切除植骨融合钛板内固定组(P0.05);(6)颈前路间盘切除植骨融合钛板内固定组内固定后出现声音嘶哑、吞咽困难发生率为19%,颈后路单开门椎管成形组患者出现伤口感染、脑脊液漏、C5神经根麻痹发生率为9%;(7)结果说明,颈前路间盘切除植骨融合钛板内固定在恢复颈椎病变节段的生理曲度以及椎间隙高度,重建颈椎的稳定性方面好于颈后路单开门椎管成形,但有出现声音嘶哑和吞咽困难风险。后路单开门椎管成形操作较为简单,但出血量和并发症相对较多。因此需要根据临床医师的操作技巧和患者的实际情况慎重选择治疗方式。
[Abstract]:Background: the main purpose of the treatment of multilevel cervical Spondylotic myelopathy is to relieve the compression of the spinal cord and restore the stability of the cervical spine to the maximum extent. Objective: to analyze the characteristics of anterior cervical discectomy and bone graft fusion with titanium plate fixation and posterior cervical open door spinal canal plasty for multilevel cervical Spondylotic myelopathy. Methods 67 patients with multisegmental cervical Spondylotic myelopathy were divided into two groups according to different treatment methods: anterior cervical disc resection and fusion with titanium plate fixation group and single open door spinal canal formation group via posterior cervical approach. The stability of cervical vertebrae such as cervical movement and cervical curvature index were observed after 12 months follow-up. The axial symptom visual analogue score and JOA score were used to record the time of operation, the amount of blood loss and the incidence of adverse reactions. Results and conclusion both groups lost part of cervical motion after internal fixation. Loss of cervical movement in posterior cervical open door spinal canal formation group was more than that in anterior cervical intervertebral disc resection, bone graft fusion, titanium plate fixation group (P0.05). Cervical curvature index was higher in anterior cervical intervertebral disc resection and bone graft fusion titanium plate fixation group than in internal fixation group. It was closer to the physiological curvature before fixation (P0.05), but there was no significant improvement in the posterior cervical open door spinal canal formation group. 3Axial symptoms in the two groups were significantly relieved than before treatment (P0.05). The axonal symptom relief in the posterior cervical open door laminoplasty group was not as good as that in the anterior cervical intervertebral disc resection and fusion titanium plate fixation group (P0.05). The nerve function of the two groups was significantly improved than that of the pre-treatment group (P0.05). There was no significant difference between the two groups (P0.05) (P0.05); (5) the amount of intraoperative bleeding in the posterior cervical open door spinal canal formation group was significantly higher than that in the anterior cervical intervertebral disc resection and bone graft fusion titanium plate fixation group (P0.05); (6) the anterior cervical intervertebral disc resection and bone graft fusion titanium plate internal fixation group was significantly higher than that in the anterior cervical intervertebral disc resection and bone graft fusion titanium plate fixation group (P0.05); (6). And then there was hoarseness, The incidence of dysphagia was 19. The incidence of wound infection and cerebrospinal fluid leakage C5 nerve root paralysis was 9 in the posterior cervical open door laminoplasty group. (7) the results showed that, Anterior disc resection and fusion with titanium plate were better in restoring the physiological curvature and intervertebral space height of cervical spondylosis and reconstructing the stability of cervical vertebrae than in posterior cervical open door spinal canal formation, but there was a risk of hoarseness and dysphagia. Posterior open-door spinal canal formation is relatively simple, but the amount of bleeding and complications are relatively high. Therefore, according to the clinician's operation skill and the patient's actual situation, the treatment method should be carefully selected.
【作者单位】：天津市人民医院脊柱一科;
【分类号】：R687.3

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