摘要
目的:观察一期前后路联合手术治疗颈椎疾患的疗效并探讨其手术适应证。方法:2002年1月～2007年12月,我科共施行一期前后路联合手术治疗颈椎疾患48例。手术患者必须同时存在两种病变,即多节段颈椎病变和脊髓/神经根前方严重压迫或C5(6)神经根前方压迫。手术步骤为先行后路双开门椎管扩大术,然后行前路椎间盘切除或椎体次全切除椎管及椎间孔减压、前方融合内固定术。随访观察治疗效果。结果:手术时间160～535min,平均226.5min,出血量180～1200ml,平均367.6ml,无一例术中死亡。手术并发症包括切口延迟愈合1例,脑脊液漏1例,右侧C5神经根麻痹1例。随访10～38个月,平均15.8个月,所有患者植骨均已融合,内固定物无松动、断裂。JOA评分由术前平均8.5分增加到术后平均14.4分(P<0.05),术后改善率为67.7%。结论:一期前后路联合手术临床应用近期疗效满意,该手术减压充分、能较好重建颈椎稳定性、可降低单纯前路手术脊髓损伤的风险和减少单纯后路手术的神经根麻痹发生率,适用于多节段颈椎病变和局部脊髓/神经根前方严重压迫且一般情况良好的患者。
Objective：To evaluate the outcome and surgical indications of one-stage combined anterior and posterior approach for cervical myelopathy.Method：From January 2002 to December 2007,48 patients underwent one-stage combined anterior and posterior approach for cervical myelopathy in our department.The enrollment criteria were multi-level involvement and severe spinal cord compression ventrally/C5（6）nerve root compression ventrally.The procedures were posterior bilateral open-door laminoplasty and decompression followed by anterior discectomy or corpectomy together with anterior fusion and internal fixation.Result：The operation time was 160-535min（average,226.5min）and the blood loss was 180-1200ml（average,367.6ml）.No one died of the operation.The complications included 1 delayed skin incision healing,1 cerebrospinal fluid leakage and 1 C5 right nerve root palsy.All patients were followed up for 10-38 months（average,15.8 months）.All patients achieved bony fusion and no instrument failure was noted.The average JOA score improved from 8.5 of pre-operation to 14.4 of post-operation,with the recovery rate of 67.7%.Conclusion：One-stage combined anterior and posterior approach,which has the features of sufficient decompression,good reconstruction of the cervical stability,lower risk of spinal cord injury compared with single anterior approach and lower incidence of nerve root palsy compared with single posterior approach,is reliable at preliminary stage and is indicated for patients with multi-level involvement and severe spinal cord or nerve root compression ventrally,and with good general condition.
出处
《中国脊柱脊髓杂志》
CAS
CSCD
北大核心
2010年第6期477-480,共4页
Chinese Journal of Spine and Spinal Cord
关键词
颈椎
减压术
前路手术
椎板成形术
Cervical spine
Decompression
Anterior approach
Laminoplasty
