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  • 饶敏杰,严宁,侯铁胜,等.颈前路混合减压融合术治疗多节段脊髓型颈椎病中期疗效及并发症分析[J].同济大学学报(医学版),2020,41(5):644-649.    [点击复制]
  • RAO Min-jie,YAN Ning,HOU Tie-sheng,et al.Mid-term clinical outcome and complications of anterior hybrid surgery in treatment of multilevel cervical spondylotic myelopathy[J].同济大学学报(医学版),2020,41(5):644-649.   [点击复制]
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颈前路混合减压融合术治疗多节段脊髓型颈椎病中期疗效及并发症分析
饶敏杰,严宁,侯铁胜,张功恒,甘心荣,徐文华,曹盛生
0
(宜春市人民医院骨科/宜春市脊柱外科重点实验室,江西 宜春336000;同济大学附属第十人民医院骨科,上海200072)
摘要:
目的探讨颈前路混合减压融合术治疗多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月至2017年10月,行颈前路混合减压融合手术治疗的多节段脊髓型颈椎病36例患者资料,男21例,女15例,年龄43~71岁,平均为(52.8±2.7)岁,对所有患者进行随访,采用疼痛视觉模拟评分(VAS)评估颈肩肢体疼痛情况,日本骨科协会(JOA)评分评估患者神经功能恢复情况,生活质量评价量表(SF-36)整体评价患者手术疗效,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,测量颈椎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34例患者获得随访,随访时间为36~72个月,平均随访时间为(50.8±4.1)个月。术前VAS为(6.9±2.2)分,高于末次随访时的(1.7±0.4)分(P<0.001)。术前JOA评分为(6.7±2.4)分,低于末次随访时的(14.8±3.6)分(P<0.001)。末次随访SF-36评分为(68.2±1.7)分,高于术前的(31.9±3.3)分(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(P<0.001)。2例患者出现内固定松动、移位,融合率为94.1%,邻近节段退变6例,螺钉断裂1例。结论颈前路混合减压融合手术治疗多节段脊髓型颈椎病,能有效恢复颈椎高度和维持颈椎曲度,是治疗多节段脊髓型颈椎病较为理想的手术方式之一。
关键词:  颈前路混合术  脊髓型颈椎病  中期疗效  手术并发症
DOI:10.16118/j.1008-0392.2020.05.017
投稿时间:2019-11-25
基金项目:江西省卫生计生委科技计划(20197495)
Mid-term clinical outcome and complications of anterior hybrid surgery in treatment of multilevel cervical spondylotic myelopathy
RAO Min-jie,YAN Ning,HOU Tie-sheng,ZHANG Gong-heng,GAN Xin-rong,XU Wen-hua,CAO Sheng-sheng
(Dept. of Orthopedics, Yichun People’s Hospital, Yichun 336000, Jiangxi Province, China;Dept. of Orthopedics, Tenth People’s Hospital, Tongji University School of Medicine, Shanghai 200072, China)
Abstract:
ObjectiveTo evaluate the mid-term clinical results and the complications in patients with multilevel cervical spondylotic myelopathy treated with anterior decompression and fusion surgery. MethodsThirty-six patients with multilevel cervical spondylotic myelopathy who underwent anterior hybrid surgery between September 2013 and October 2016 were enrolled. There were 21 males and 15 females with a mean age of (52.8±2.7) years (43-71 years). The neck and shoulder pain were evaluated by visual analogue scale(VAS), neurological function was measured using Japanese Orthopedic Association(JOA) scores and the quality of life of patients was evaluated by SF-36 scores. X-rays were conducted before and after surgery for cervical height, physiological curvature and fusion rate. Complications of the patients were recorded and analyzed. ResultsThirty four cases completed the follow-up with a mean follow-up time of (50.8±4.1) months(36-72 months). At the final follow-up, the VAS scores reduced from (6.9±2.2) points to (1.7±0.4) points(P<0.001), the JOA scores increased from (6.7±2.4) points to (14.8±3.6) points(P<0.001), and the SF-36 scores increased from (31.9±3.3) points to (68.2±1.7) points(P<0.001) compared with those before treatment; meanwhile, the cervical height and physiological curvature showed significant improvement compared with pre-operation(P<0.001); and the fusion rate was 94.1%. Eleven patients presented with related complications, including 1 case of cerebral fluid leakage, 2 cases of temporary dysphagia, 1 case of axial neck pain, 1 case of C5 palsy, 6 cases of adjacent segment diseases, and 2 cases of looseness and displace of the internal fixation and 1 case of screw extraction. ConclusionAnterior hybrid surgery presents a satisfactory mid-term efficacy in restoring the height of cervical vertebra and the curvature of cervical vertebra for patients with multilevel cervical spondylotic myelopathy.
Key words:  anterior hybrid surgery  cervical spondylotic myelopathy  mid-term clinical effects  postoperative complications

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