颈前路手术治疗4个节段脊髓型颈椎病的中期疗效分析

The mid-term clinical outcome of anterior surgical in the treatment of 4-level cervical spondylotic myelopathy

中文关键词:  颈前路手术  脊髓型颈椎病  中期疗效  手术并发症

英文关键词:Anterior cervical surgery  Cervical spondylotic myelopathy  Postoperative complications  Mid-term clinical effects

中文摘要:

  【摘要】 目的：探讨颈前路手术治疗4个节段脊髓型颈椎病的中期临床效果及其并发症分析。方法：回顾性分析2013年9月～2016年10月，行颈椎前路手术治疗的4个节段脊髓型颈椎病31例患者资料，男18例，女13例，年龄54～74岁，平均58.1±4.9岁，对所有患者进行随访，采用疼痛视觉模拟评分（visual analogue scale，VAS）评估颈肩肢体疼痛情况，日本骨科协会（Japanese Orthopedic Association，JOA）评分评估患者神经功能恢复情况，行颈椎正侧位及过伸过屈位X线片，观察钛网等内固定情况，测量C2～C7颈椎椎体高度和颈椎生理曲度，评估植骨融合情况。并记录患者手术相关并发症。结果：27例患者获得随访，随访时间为35~72个月，平均52.7±3.6个月。末次随访时VAS为1.6±0.6分，低于术前的7.2±1.5分，差异有统计学意义（P<0.001）。末次随访JOA评分为16.1±4.2分，高于术前的8.8±3.7分，差异有统计学意义（P<0.001）。至末次随访时，患者颈椎椎体高度及颈椎曲度较术前均有明显改善，差异有统计学意义（P<0.001）。所有患者均获得骨性融合，27例患者共出现19例次并发症，脑脊液漏3例，一过性吞咽困难2例，轴性症状1例，C5神经根麻痹2例，邻近节段退变6例，钛网下沉2例，内固定松动、移位2例，螺钉断裂1例。结论：颈前路手术治疗脊髓前方受压为主的4个节段脊髓型颈椎病，能有效恢复颈椎高度和维持颈椎曲度，其中期疗效满意。

英文摘要:

  【Abstract】 Objectives: To investigate the mid-term clinical results and the complications of patients with 4-level cervical spondylotic myelopathy who underwent anterior decompression and fusion surgery. Methods: Between September 2013 and October 2016, 31 patients of 4-level cervical spondylotic myelopathy who underwent anterior cervical surgery were included. There were 18 males and 13 females, whose mean age was 58.1±4.9 years old(range, 54-74 years). The neck and shoulder pain were evaluated by visual analogue scale(VAS), and neurological function measured using Japanese Orthopedic Association(JOA) scores. X-rays were conducted before and after surgery for cervical height, physiological curvature of C2-C7 and fusion rate. Complications of the patients were recorded and analyzed as well. Results: 27 cases completed the follow-up. The mean follow-up time was 52.7±3.6 months(35-72 months). At final follow-up, the VAS scores reduced from preoperative 7.2±1.5 points to 1.6±0.6 points(P<0.001), and the JOA scores increased from preoperative 8.8±3.7 points to 16.1±4.2 points(P<0.001). At final follow-up, the cervical height and physiological curvature showed significant improvement compared with pre-operation(P<0.001). The fusion rate was 100％. 15 patients presented with related complications, including 3 cases of cerebral fluid leakage, 2 cases of temporary dysphagia, 1 cases of axial neck pain, 4 cases of C5 palsy, 6 cases of adjacent segment diseases, 2 cases of graft subsidence, 2 cases of looseness and displace of the internal fixation and 1 case of screw extraction. Conclusions: Anterior cervical surgery for 4-level cervical spondylotic myelopathy is a challenging surgical technique, restoring the height of cervical vertebra and the curvature of cervical vertebra, with good results for the mid-term efficacy of clinical effects.