前路减压联合钛网及自锁定椎间融合器治疗多节段脊髓型颈椎病

Anterior decompression and reconstruction with the titanium mesh cage plus plate and self-locking stand-alone cage for the treatment of multi-level cervical spondylotic myelopathy

中文关键词:  多节段脊髓型颈椎病  前路减压  融合  自锁定融合器  钛网

英文关键词:Multi-level cervical myelopathy  Anterior decompression  Fusion  Self-locking stand-alone cage  Titanium mesh cage

中文摘要:

  【摘要】 目的：评价前路减压、钛网及自锁定融合器联合重建治疗多节段脊髓型颈椎病的临床疗效及安全性。方法：回顾性分析2012年1月～2014年8月我院行前路减压、钛网与自锁定融合器联合重建治疗的多节段脊髓型颈椎病患者，共32例。其中男17例，女15例。年龄53～74岁，平均65.7±4.2岁。患者影像学上均表现为连续3个节段及以上的脊髓受压，且保守治疗无效。所有患者均为脊髓型颈椎病患者，其中11例患者合并神经根型颈椎病。采用JOA评分及Odom标准评价神经功能及临床效果。观察并记录手术的并发症、融合率、融合器下沉及手术后颈椎生理曲度的变化。结果：手术均顺利完成，钛网及融合器置入成功。平均手术时间113.0±12.5min；术中平均失血量123.0±9.4ml。平均随访时间23.2±2.3个月（12～41个月）。末次随访时JOA评分及颈椎生理曲度均较术前明显增加，并有统计学意义（P＜0.05）。32例患者均获得融合，平均融合时间6.4±0.7个月。无内固定失败，无浅表及深部感染。术后并发症包括脑脊液漏1例（3.1%），经保守治疗7d后治愈。钛网沉降2例（6.2%），患者无临床症状；自锁定融合器无沉降。无吞咽困难及声音嘶哑。根据Odom标准，术后疗效优11例，良好17例，一般4例。结论：前路减压、钛网及自锁定融合器联合重建治疗多节段脊髓型颈椎病，安全有效，能够有效恢复颈椎曲度，减少长钛板相关并发症，并获得满意临床结果。

英文摘要:

  【Abstract】 Objectives: To evaluate the clinical and radiological results of the reconstruction with titanium mesh cage plus plate and self-locking stand-alone cage for treating multi-level(≥3) cervical spondylotic myelopathy(CSM). Methods: From January 2012 to August 2014, 32 consecutive patients with multi-level CSM were treated with anterior decompression and reconstruction with titanium mesh cages plus plate and self-locking stand-alone cages, including 17 males and 15 females. The age ranged from 53 to 74 years (mean, 65.7±4.2 years) at surgery. All patients had symptoms and signs of nerve compression at multiple segments that were refractory to conservative treatment. Clinical outcomes were evaluated by using JOA scores and Odom criteria. Complications, fusion rate and time, cages subsidence and spinal curvature were assessed. Results: The operations were completed successfully, the titanium mesh and self-locking stand-alone cage were successfully placed. The average operation time was 113.0±12.5min, and the average blood loss was 123.0±9.4ml. The mean follow-up period was 23.2±2.3 months(12-41 months). The JOA score and degree of spinal curvature significantly increased at the final follow-up compared with preoperative ones(P<0.05). All cases finally achieved a solid fusion, and the time of solid fusion was 6.4±0.7 months. Postoperative complications included cerebrospinal fluid leakage in 1(3.1%) which was cured after 7d of conservative treatment and titanium mesh subsidence in 2(6.2%) which had no clinical symptoms. No dysphagia and hoarseness occurred. According to the Odom criteria, 11 patients got an excellent outcome, 17 patients got a good outcome and 4 patients showed a fair outcome. Conclusions: Anterior decompression and reconstruction with titanium mesh cage plus plate and self-locking stand-alone cage can be used safely and effectively for CSM. This procedure can effectively restore cervical lordosis, reduce the complications related to long plate fixation, and lead to satisfactory outcomes.