前路经椎间隙减压植骨融合术治疗老年多节段脊髓型颈椎病的疗效观察

Multilevel anterior discectomy and fusion for aged patients with cervical spondylotic myelopathy

中文关键词:  脊髓型颈椎病  多节段  椎间盘切除术  脊柱融合术  老年

英文关键词:Cervical spondylotic myelopathy  Multilevel  Discectomy  Spine fusion  Aged

中文摘要:

  【摘要】 目的：观察颈前路经椎间隙减压植骨融合内固定术治疗老年多节段脊髓型颈椎病的疗效。方法：2004年3月~2009年3月采用颈前路连续3或4节段经椎间隙减压、cage植骨、钛板螺钉内固定术治疗老年脊髓型颈椎病患者27例，男15例，女12例；年龄61～75岁，平均66.5±5.1岁；C3~C6 11例，C4~C7 9例，C3~C7 7例。术前及末次随访时行JOA评分、颈部功能障碍指数（NDI）评定，末次随访时行Odom′s临床疗效评定；术前及末次随访时在颈椎侧位X线片上测量颈椎融合节段曲度（Cobb角），观察植骨融合情况。结果：手术时间112.9±28.2min，术中出血量78.9±52.8ml。术中1例发生脑脊液漏，未行硬膜修补，常规放置负压引流管，术后24h拔管，切口愈合良好；术后2例出现吞咽异物感，未特殊治疗2个月后消失。随访6～60个月，平均23.8±7.5个月，JOA评分由术前9.5±1.8分提高到末次随访时的13.6±1.2分，NDI由术前19.0%±3.4%降低到末次随访时的7.8%±2.2%，颈椎融合节段前凸Cobb角由术前的8.8°±1.2°增加到术后的18.0°±2.5°，差异均有统计学意义（P<0.001）；末次随访时Odom′s临床疗效评定，优8例，良15例，中4例，优良率为85.2%；末次随访时cage及内固定位置良好，植骨均融合。结论：颈前路经椎间隙减压、cage植骨、钛板螺钉内固定术治疗老年多节段脊髓型颈椎病可获得较满意的临床效果。

英文摘要:

  【Abstract】 Objective：To investigate the efficacy of multilevel anterior cervical discectomy and fusion for aged patients with cervical spondylotic myelopathy.Method：Twenty seven patients（15 males and 12 females） with the mean age of 66.5±5.1 years（range，61-75 years） treated surgically between March 2004 and March 2009 were reviewed retrospectively.Multilevel（including C3-C6 in 11 case，C4-C7 in 9，C3-C7 in 7） anterior cervical discectomy and fusion with cage and dynamic titanium plate were performed.Japanese Orthopedic Association（JOA） scores and neck dysfunction index（NDI），as well as radiologic parameters such as cervical lordosis of fusion segement before and after operation were noted and compared.Improving rate of JOA and bony fusion were also evaluated.Clinical results were graded from excellent to poor using the Odom′s criteria.The sagittal alignment of fusion segements were measured using Cobb method.Result：The average operation time was 112.9±28.2min（range，75-180min），and mean blood loss was 78.9±52.8ml（range，50-300ml）.One patient was complicated with cerebrospinal fluid leakage which healed after conventional drain for 24h without surgical intervention.Another two cases had swallowing foreign body sensation，which disappeared after two months.All patients were followed up for 6-60 months，with an average of 23.8±7.5 months.The JOA score at final follow up（13.6±1.2） was significantly higher than preoperative（9.5±1.8）（P<0.001）.NDI at final follow up（7.8%±2.2%） was significant lower than preoperative（19.0%±3.4%）(P<0.001)．Radiograph analysis indicated that the average angle of lordosis was corrected from 8.8°±1.2° preoperatively to 18.0°±2.5° at final follow up（P<0.001）.The final follow up score according to Odom′s criteria was excellent in eight patients，good in fifteen and fair in remaining four，with excellent and good rate of 85.2%.At final follow up，no cage subsidence and displacement was noted and bony fusion rate was 100%.Conclusion：Multilevel anterior discectomy and fusion for aged patients with cervical spondylotic myelopathy is reliable and effective.