CAJ | 학술논문

背景:目前应用前路减压内固定方法治疗脊髓型颈椎病得到了普遍认可,但大宗病例的临床报告并不常见.目的:探讨颈椎前路减压植骨结合锁定钛板内固定治疗脊髓型颈椎病的疗效.方法:回顾性分析了2001-01/2007-08于黄冈市中心医院骨科行前路椎体次全切减压、取髂骨植骨或钛网植骨结合前路锁定钛板固定术治疗的118例脊髓型颈椎病患者.根据术前、术后即刻及术后随访颈椎标准侧位X射线片,测量融合节段前凸Cobb角、融合节段椎体前缘高度及后缘高度,并评估植骨融合情况;JOA标准评价神经功能.结果与结论:随访期间(6～32个月,平均19个月)3例出现钛网轻度沉陷,所有病例无内固定断裂、松动,末次随访骨融合率为100%.与术前比较,术后即刻及末次随访时患者的JOA评分明显增高(P＜0.05),术后末次随访优良率为86 2%;术后Cobb角、融合节段椎体前缘高度及后缘高度值也较术前明显改善(P＜0.05).说明前路次全切减压植骨锁定钛板内固定治疗脊髓型颈椎病,既能彻底减压又能有效矫正颈椎畸形,坚固骨融合重建稳定,临床效果满意.
배경:목전응용전로감압내고정방법치료척수형경추병득도료보편인가,단대종병례적림상보고병불상견.목적:탐토경추전로감압식골결합쇄정태판내고정치료척수형경추병적료효.방법:회고성분석료2001-01/2007-08우황강시중심의원골과행전로추체차전절감압、취가골식골혹태망식골결합전로쇄정태판고정술치료적118례척수형경추병환자.근거술전、술후즉각급술후수방경추표준측위X사선편,측량융합절단전철Cobb각、융합절단추체전연고도급후연고도,병평고식골융합정황;JOA표준평개신경공능.결과여결론:수방기간(6～32개월,평균19개월)3례출현태망경도침함,소유병례무내고정단렬、송동,말차수방골융합솔위100%.여술전비교,술후즉각급말차수방시환자적JOA평분명현증고(P＜0.05),술후말차수방우량솔위86 2%;술후Cobb각、융합절단추체전연고도급후연고도치야교술전명현개선(P＜0.05).설명전로차전절감압식골쇄정태판내고정치료척수형경추병,기능철저감압우능유효교정경추기형,견고골융합중건은정,림상효과만의.
BACKGROUND: Anterior decompression and internal fixation for treatment of cervical spondylotic myelopathy has been widely accepted. However, there are few clinical case reports regarding this.OBJECTIVE: To investigate the curative efficacy of anterior cervical decompression combined with bone grafting and titanium plate internal fixation in treatment of cervical spondylotic myelopathy.METHODS: A total of 118 patients with cervical spondylotic myelopathy who underwent anterior cervical subtotal vertebrectomy,iliac bone grafting (or bone grafting with titanium cage) and anterior locking titanium plate internal fixation at the Department of Orthopedics, Huang Gang Central Hospital of Hubei Province between January 2001 and August 2007 were retrospectively analyzed. According to the X-ray photographs taken before, immediately after surgery and during postoperative follow-up periods,Cobb's angle, anterior vertebral height and posterior vertebral height of fused segments. Bone graft fusion was evaluated.Neurological function was assessed according to Japanese Orthopaedic Association (JOA) scores.RESULTS: During the follow-up period (6-32 months, mean 19 months), three patients presented with slight titanium mesh sinking, and no fragmentation or loosening during internal fixation was observed in all patients, with a final bone fusion rate of 100％. JOA scores obtained immediately after surgery and during last follow-up were significantly greater compared with those obtained prior to surgery (P ＜ 0.05). The excellent and good rate of neurological function recovery during the last follow-up was 86.2％. After surgery, sagittal Cobb's angle, anterior and posterior vertebral heights of fused segments were significantly improved(P ＜ 0.05). These findings indicate that anterior cervical subtotal decompression combined with bone grafting and titanium plateinternal fixation for treatment of cervical spondylotic myelopathy can thoroughly decompress, effectively correct cervical vertebrae malformation, and achieve stable bone fusion and reconstruction, with satisfactory clinical efficacy.