CAJ | 학술논문

目的:总结前后路一期手术时应用自体C7棘突骨行椎间植骨融合治疗脊髓型颈椎病(CSM)的临床疗效.方法:2004年2月至2008年12月,对30例脊髓前后方均有压迫的CSM患者采用一期前后路手术,其中男21例,女9例,年龄39～70岁,平均54.5岁;术前JOA评分4～13分,平均7.6±2.5分.后路手术时切取C7棘突骨作为前路椎间植骨融合的材料.观察患者术后神经功能改善和椎间植骨融合情况.结果:手术时间3.0～5.0h,平均3.5h;术中出血量270～600ml,平均380ml.未发生脊髓神经症状加重、感染、脑脊液漏等并发症.随访6～50个月,平均24.2个月,末次随访时JOA评分9～15分,平均13.7±1.8分,平均改善率为72%,其中优7例,良18例,好转5例.椎间植骨全部获得融合,未见植骨块塌陷和移位,内固定无松动和断裂.结论:对脊髓前后方均有压迫的CSM患者采用一期前后路手术减压可取得良好的效果,将后路手术时切取的自体C7棘突骨用于前路椎间植骨具有取骨简便、融合率高及相对节省治疗费用的优点.
목적:총결전후로일기수술시응용자체C7극돌골행추간식골융합치료척수형경추병(CSM)적림상료효.방법:2004년2월지2008년12월,대30례척수전후방균유압박적CSM환자채용일기전후로수술,기중남21례,녀9례,년령39～70세,평균54.5세;술전JOA평분4～13분,평균7.6±2.5분.후로수술시절취C7극돌골작위전로추간식골융합적재료.관찰환자술후신경공능개선화추간식골융합정황.결과:수술시간3.0～5.0h,평균3.5h;술중출혈량270～600ml,평균380ml.미발생척수신경증상가중、감염、뇌척액루등병발증.수방6～50개월,평균24.2개월,말차수방시JOA평분9～15분,평균13.7±1.8분,평균개선솔위72%,기중우7례,량18례,호전5례.추간식골전부획득융합,미견식골괴탑함화이위,내고정무송동화단렬.결론:대척수전후방균유압박적CSM환자채용일기전후로수술감압가취득량호적효과,장후로수술시절취적자체C7극돌골용우전로추간식골구유취골간편、융합솔고급상대절성치료비용적우점.
Objective:To investigate the clinical effect of ane-stage anterior and posterior decompression and interbody fusion using C7 spinous process for cervical spondylotic myelopathy (CSM).Method:From February 2004 to December 2008,30 patients with spinal cord compression both ventrally and dorsally underwent one-stage anterior and posterior decompression surgery.There were 21 males and 9 females with the average age of 54.5 years (range,39-70 years).The average JOA score was 7.6±2.5 (range,4 to 13) preoperatively. The spinous process of C7 harvested in posterior approach was used as graft material in anterior approach. All cases were followed up to investigate the interbody fusion status,neurological function and complications.Re-suit:The mean operative time was 3.5 hours (range,3.0-5.0 hours),the mean blood loss was 38Oral(range, 270-600ml).There were no severe complications such as skin incision infection,internal fixation failure,cere-brospinai fluid leakage and deteriorated neurological function.The mean follow-up period was 24.2 months (range,6-50 months) .Satisfactory outcome was obtained postoperatively.The average JOA score was 13.7±1.8 at final follow up (range , 9-15) .The average recovery rate of neurological function was 72% at the final fol-low-up,which showed excellent in 7 cases,good in 18 cases,improved in 5 cases and no poor.All 30 seg-ments got bony fusion with no graft subsidence.Conclusion:One-stage anterior and posterior decompression and interbody fusion using C7 spinous process for cervical spondylotic myelopathy is reliable,which has high fusion rate as well as shortening operation time and lowering cost.