CAJ | 학술논문

目的探讨单纯前路手术治疗“钳夹型”颈椎病的疗效及影响疗效的因素.方法回顾性分析自2003年1月至2009年12月采用前路减压植骨融合治疗“钳夹型”颈椎病且影像学、随访资料完整的82例病历资料,男43例,女39例;年龄33～79岁,平均(54.4±8.6)岁.正中矢状位MRI测量手术前后的椎管总占位率、前方占位率(anterior occupying rate,AOR)及后方占位率(posterior occupying rate,POR).对术前占位率、椎间隙高度、术后影像学改变与神经功能改善情况进行相关性分析.结果患者均获得9～72个月随访,平均(25.8±10.6)个月.术后日本骨科协会评分(Japanese Orthopaedic Association Scores,JOA),AOR、POR及椎间隙高度术后测量值较术前均有明显改善.术前POR平均为29.0％+10.5％,术后平均为19.9％±11.6％,POR改善率平均为9.0％±6.1％.统计分析显示术前椎间高度丢失与术前POR无相关性,术前POR与POR改善率有相关性.术前POR在20％～40％的病例术后JOA评分改善明显,术前POR≥40％的病例前路间接减压效果较差.结论通过前路减压撑开、植骨融合固定重建颈椎曲度和椎间隙高度,可达到间接后方减压的目的.术前POR在20％～40％的患者后方间接减压效果较好.
목적 탐토단순전로수술치료“겸협형”경추병적료효급영향료효적인소.방법 회고성분석자2003년1월지2009년12월채용전로감압식골융합치료“겸협형”경추병차영상학、수방자료완정적82례병력자료,남43례,녀39례;년령33～79세,평균(54.4±8.6)세.정중시상위MRI측량수술전후적추관총점위솔、전방점위솔(anterior occupying rate,AOR)급후방점위솔(posterior occupying rate,POR).대술전점위솔、추간극고도、술후영상학개변여신경공능개선정황진행상관성분석.결과 환자균획득9～72개월수방,평균(25.8±10.6)개월.술후일본골과협회평분(Japanese Orthopaedic Association Scores,JOA),AOR、POR급추간극고도술후측량치교술전균유명현개선.술전POR평균위29.0％+10.5％,술후평균위19.9％±11.6％,POR개선솔평균위9.0％±6.1％.통계분석현시술전추간고도주실여술전POR무상관성,술전POR여POR개선솔유상관성.술전POR재20％～40％적병례술후JOA평분개선명현,술전POR≥40％적병례전로간접감압효과교차.결론 통과전로감압탱개、식골융합고정중건경추곡도화추간극고도,가체도간접후방감압적목적.술전POR재20％～40％적환자후방간접감압효과교호.
Objective To investigate effect of single anterior decompression and fusion for pinching cervical spondylosis myelopathy.Methods 82 patients with pinching cervical spondylosis myelopathy,treated with single anterior decompression and fusion,were analyzed,including 43 males and 39 females,with an average age of 54.4 years (range,33-79 years).Occupying rate,anterior occupying rate and posterior occupying rate were measured on pre- and post-operative midsagittal MRIs.Multiple regression analysis was performed between preoperative occupying rate,intervertebral space height,postoperative imaging changes and neural function recovery.Results All patients were followed up for an average of 25.8 months (range,9-72 months).Significant differences were found between pre- and postoperative Japanese Orthopaedic Association (JOA) scores,anterior occupying rate,posterior occupying rate,and intervertebral space height,respectively.Pre- and post-operative posterior occupying rate was averagely 29.0％±10.5％ and 19.9％+11.6％,respectively,and improvement rate of posterior occupying rate was 9.0％±6.1％.Regression analysis found that preoperative intervertebral space height did not relate to posterior occupying rate,while preoperative posterior occupying rate related to improvement rate of posterior occupying rate.JOA scores improved significantly after operation in patients with preoperative posterior occupying rate between 20％ and 40％.However,the decompression results were poor in patients with preoperative posterior occupying rate ≥40％.Conclusion Anterior decompression and fusion can achieve satisfactory results in patients with pinching cervical spondylotic myelopathy.For patients with preoperative posterior occupying rate between 20％ and 40％,the decompression results are better.