Smith-Robinson技术联合保留椎体后壁的椎体次全切除术治疗多节段颈椎病

Smith-Robinson technique combined with corpectomy with the posterior vertebral wall intact to treat multi-level cervical spondylosis

中文关键词:  颈椎病  减压术  Smith-Robinson技术  椎体次全切除  临床疗效

英文关键词:Cervical spondylosis  Decompression  Smith-Robinson technique  Corpectomy  Clinical efficacy

中文摘要:

  【摘要】 目的：探讨采用Smith-Robinson技术（前路经椎间隙减压+植骨融合术）联合保留椎体后壁的椎体次全切除术治疗多节段（≥3个节段）颈椎病的临床疗效。方法：2010年1月～2014年1月，我科采用Smith-Robinson技术联合保留椎体后壁的椎体次全切除术治疗多节段颈椎病33例，男25例，女8例；年龄52.6±9.7岁（42～71岁）。脊髓型23例，混合型10例（脊髓型+神经根型6例，脊髓型+神经根型+椎动脉型4例）。病变节段：C3/4～C5/6 12例，C4/5～C6/7 14例，C3/4～C6/7 7例。保留后壁次全切除的椎体：C4 8例、C5 18例、C6 7例，其余病变间隙采用Smith-Robinson技术减压。术前、术后即刻及术后1、6、12个月摄颈椎正侧位X线片，术后3个月行颈椎CT重建，了解内固定物的位置，以Bohlman法结合CT重建评估植骨融合情况。术前、术后1个月及末次随访时以JOA评分法评价患者的神经功能，以目测类比疼痛评分（VAS）评估患者的颈肩痛，测量颈椎侧位C2～C7 Cobb角以评估颈椎生理曲度的恢复情况。结果：手术时间为105±24min（95～138min）；术中出血量为270±95ml（180～450ml）。术后4例出现声音嘶哑，2～3周后自愈。2例中途失访，31例患者获得16.3±5.6个月（12～24个月）的随访。术后1个月JOA评分、VAS评分均较术前明显改善（P<0.05）。末次随访时JOA评分、VAS评分较术后1个月时明显改善（P<0.05），其中优18例，良10例，有效3例，优良率为90.3%。术后1个月时的C2～C7 Cobb角度较术前明显改善（P<0.05），而末次随访与术后1个月比较差异无显著性（P>0.05）。术后3～6个月植骨全部融合，无钢板松动、钛网或cage移位、椎体塌陷、假关节形成等并发症发生。结论：Smith-Robinson技术联合保留椎体后壁的椎体次全切除术治疗多节段颈椎病疗效满意、操作安全、减压彻底、植骨融合可靠及术后并发症少。

英文摘要:

  【Abstract】 Objectives: To study the effect of smith-Robinson technique combined with cervical corpectomy with the posterior vertebral wall intact(anterior decompression through disc space and interbody fusion with bone graft) for multi-level(≥3) cervical spondylosis. Methods: 33 cases with multi-level（≥3） cervical spondylosis were treated with corpectomy with the posterior vertebral wall retention combined with Smith-Robinson technique from January 2010 to January 2014. There were 25 males and 8 females with an average age of 52.6±9.7 years(range, 42-71 years). 23 patients were diagnosed as cervical spondylotic myelopathy, and 10 patients were mixed type(myelopathy type + radiculopathy type in 6 cases, myelopathy type + radiculopathy type + vertebral artery type in 4 cases). The diseased segments were as follows: 12 cases at C3/4-C5/6, 14 cases at C4/5-C6/7 and 7 cases at C3/4-C6/7. 8 cases at C4, 18 cases at C5 and 7 cases at C6. All cases underwent the surgery of retained posterior vertebral wall at subtotal corpectomy and the adjacent discs were decompressed by Smith-Robinson technique. The position of the internal fixities was detected by X-rays (preoperation, and immediately after operation, the 1st, 6th, and 12th month after surgery) and CT-scan(the 3rd month after operation) and the fusion was evaluated by Bohlman method under CT scan. Neck and shoulder pain and neurological function was evaluated by the visual analog scale(VAS) and Japanese Orthopedic Association(JOA) score and the physiological curvature of cervical spine was assessed by measuring the C2-C7 Cobb angle preoperatively, 1 month postoperatively and at final follow-up. Results: The mean operation time was 105±24min(95-138min) and the mean blood loss was 270±95ml(180-450ml). 4 patients with postoperative hoarseness healed 2-3 weeks later. 2 cases were lost follow-up and 31 patients were followed up for 16.3±5.6 months(range, 12-24 months). The JOA score and VAS score improved significantly and showed significant difference(P<0.05) between the preoperation and 1 month after operation. At last follow-up, the value improved significantly compared with 1 month after operation(P<0.05). Among them, 18 cases were excellent, 10 good, 3 effective, with the excellent and good rate as 90.3%. 1 month after operation, C2-C7 Cobb angle increased obviously(P<0.05) compared with the preoperative ones. But there was no significant difference(P<0.05) between 1 month after surgery and the last follow-up. Bony fusion was noted in 31 patients at 3 to 6 months after operation. The complications such as plate loosening, titanium mesh and cage shift, vertebral collapse, pseudoarticulation formation were not noted. Conclusions: For multi-level cervical spondylosis, corpectomy with the posterior vertebral wall retention combined with Smith-Robinson technique is feasible and safety method, which can obtain complete decompression, reliable bony fusion and reducing complications.