CAJ | 학술논문

目的:总结后路单开门与一期前后路联合手术减压治疗前后受压脊髓型颈椎病的疗效,探讨一期前后路联合减压的手术适应证.方法:1996年2月至2007年12月,对67例前后方均受压的脊髓型颈椎病患者分别采用后路单开门神经根管扩大减压术(A组,36例)或一期前后路联合减压术(B组,31例)治疗.随访患者临床和影像学情况,手术前后按日本矫形外科学会(JOA)评分标准评定神经功能,计算改善率,比较两组l临床疗效.结果:A组手术时间1～1.5h,平均72min;术中出血量110～500ml,平均370ml;无明显术中并发症发生,术后1例出现肩部放射痛.B组手术时间3～5h,平均3.6h;术中出血量400～1300ml,平均710ml;术中出现脑脊液漏4例.随访6个月～8年,平均28个月,前路植骨及后路门轴全部骨性愈合.A组神经功能改善率为72.4%.优良率为80.1%;MRI检查显示34例脊髓明显后移、前后方软性压迫解除、脑脊液通畅,2例显示脊髓明显后移、前方仍存在骨化块轻度压迫、予以二期前路骨化块切除减压、内固定术,随访时21例显示前方椎间盘突出明显消失或缩小;CT显示椎管扩大充分,开门度数平均为63.2°.B组神经功能改善率为74.1%,优良率为80.6%;MRI显示31例脊髓前后方压迫均解除、脑脊液通畅;CT显示椎管扩大充分.开门度数平均为53.3°.两组神经功能改善率和优良率均无统计学差异.结论:后路单开门减压治疗前方软性压迫的前后受压脊髓型颈椎病可使脊髓充分后移躲避前方的压迫,术后脊髓前方的软性压迫缩小或消失,疗效肯定;但对椎管狭窄合并脊髓前方超过椎管50%的骨性压迫者疗效欠佳,应采用一期或二期前后路联合减压治疗.
목적:총결후로단개문여일기전후로연합수술감압치료전후수압척수형경추병적료효,탐토일기전후로연합감압적수술괄응증.방법:1996년2월지2007년12월,대67례전후방균수압적척수형경추병환자분별채용후로단개문신경근관확대감압술(A조,36례)혹일기전후로연합감압술(B조,31례)치료.수방환자림상화영상학정황,수술전후안일본교형외과학회(JOA)평분표준평정신경공능,계산개선솔,비교량조l림상료효.결과:A조수술시간1～1.5h,평균72min;술중출혈량110～500ml,평균370ml;무명현술중병발증발생,술후1례출현견부방사통.B조수술시간3～5h,평균3.6h;술중출혈량400～1300ml,평균710ml;술중출현뇌척액루4례.수방6개월～8년,평균28개월,전로식골급후로문축전부골성유합.A조신경공능개선솔위72.4%.우량솔위80.1%;MRI검사현시34례척수명현후이、전후방연성압박해제、뇌척액통창,2례현시척수명현후이、전방잉존재골화괴경도압박、여이이기전로골화괴절제감압、내고정술,수방시21례현시전방추간반돌출명현소실혹축소;CT현시추관확대충분,개문도수평균위63.2°.B조신경공능개선솔위74.1%,우량솔위80.6%;MRI현시31례척수전후방압박균해제、뇌척액통창;CT현시추관확대충분.개문도수평균위53.3°.량조신경공능개선솔화우량솔균무통계학차이.결론:후로단개문감압치료전방연성압박적전후수압척수형경추병가사척수충분후이타피전방적압박,술후척수전방적연성압박축소혹소실,료효긍정;단대추관협착합병척수전방초과추관50%적골성압박자료효흠가,응채용일기혹이기전후로연합감압치료.
Objective:To investigate the clinical outcome and indication of posterior single-door laminoplasty and combined posterior-anterior decompression for severe cervical spondylosis.Method:Retrospective analysis of 67 cases with severe cervical spondylosis was performed,two different surgical protocols were assigned as follows: group A had 36 cases undergoing routine posterior laminoplasty and decompression and group B had 31 cases undergoing combined anterior and posterior decompression.JOA (Japanese Orthopedic Association) score system was used to evaluate the neurofunction.The clinical outcome between two groups were reviewed and compared.Result:In group A,the surgical time was 1～1.5h (mean,72min),blood loss was 110～500ml(av-erage,370ml).No intraoperative complication was noted except shoulder radiated pain in 1 case.While in group B,the counterparts were 3～5h(mean,3.6h) and 110～500ml(mean,710ml) respectively.CSF leakage was noted in 4 cases.All cases were followed up for 6 months to 8 years(mean,28 months),anterior bony graft and door axial had bony union.Group A had neurofunction improve rate of 72.4% ,excellent to good rate of 80.1%, MRI showed spinal cord moved dorsally and decompression in 34 cases,while 2 cases had still bony com-pressed ventrally despite of complete canal enlargement which was followed by anterior decompression.CT showed the door open degree was 63.2°.In group B,the neurofunction improve rate was 74.1% with excellent to good rate of 80.6%,MRI showed spinal cord moved dorsally and decompression in 31 cases,CT showed the door open degree was 53.3°,which showed no significant difference between two groups.Conclusion:The posterior laminoplasty for spinal cord compression both ventrally and dorsally can have spinal cord moved dorsally and make the anterior compressor retract or disappear,however for those having canal stenosis over 50% ,this protocol is not applicable ,combined anterior and posterior approach should be considered.