CAJ | 학술논문

目的探讨前路跳跃性椎体次全切、分节段减压植骨融合术治疗多节段脊髓型颈椎病及后纵韧带骨化症的疗效.方法 15例多节段(≥3个节段)脊髓型颈椎病或后纵韧带骨化症患者均接受前路跳跃性椎体次全切除减压+自体髂骨或钛网植骨融合+前路钢板固定术.男9例,女6例;年龄51～80岁,平均56岁.术中对C4、C6椎体行次全切,在保留C5椎体基础上切除其后缘增生骨赘、突出的椎间盘和(或)骨化的后纵韧带,在C3～5和C5～7进行结构性植骨,以C5椎体为中间固定椎体行颈前路钢板内固定.术后采用日本骨科协会(Japanese Orthopaedic Association,JOA)评分系统评估神经功能恢复情况;摄X线片和三维CT重建评估融合程度;同时行MR检查,以观察脊髓减压程度和脊髓情况.结果所有患者均获得9～42个月随访,平均26.7个月.15例患者均达到骨性融合.JOA评分由术前平均(13.44+2.81)分改善至术后(16.16±2.19)分.颈椎序列由术前1.16°+11.74°改善至术后即刻14.36°±7.85°,末次随访时为12.92°±6.17°.术后声嘶2例,吞咽困难1例.结论前路选择性椎体次全切除结合分节段减压植骨融合术治疗多节段脊髓型颈椎病及后纵韧带骨化症疗效可靠.保留C5椎体提供了额外的把持力、增加了结构的稳定性,避免跨多节段植骨内固定而导致的内固定失败.
목적 탐토전로도약성추체차전절、분절단감압식골융합술치료다절단척수형경추병급후종인대골화증적료효.방법 15례다절단(≥3개절단)척수형경추병혹후종인대골화증환자균접수전로도약성추체차전절제감압+자체가골혹태망식골융합+전로강판고정술.남9례,녀6례;년령51～80세,평균56세.술중대C4、C6추체행차전절,재보류C5추체기출상절제기후연증생골췌、돌출적추간반화(혹)골화적후종인대,재C3～5화C5～7진행결구성식골,이C5추체위중간고정추체행경전로강판내고정.술후채용일본골과협회(Japanese Orthopaedic Association,JOA)평분계통평고신경공능회복정황;섭X선편화삼유CT중건평고융합정도;동시행MR검사,이관찰척수감압정도화척수정황.결과 소유환자균획득9～42개월수방,평균26.7개월.15례환자균체도골성융합.JOA평분유술전평균(13.44+2.81)분개선지술후(16.16±2.19)분.경추서렬유술전1.16°+11.74°개선지술후즉각14.36°±7.85°,말차수방시위12.92°±6.17°.술후성시2례,탄인곤난1례.결론 전로선택성추체차전절제결합분절단감압식골융합술치료다절단척수형경추병급후종인대골화증료효가고.보류C5추체제공료액외적파지력、증가료결구적은정성,피면과다절단식골내고정이도치적내고정실패.
Objective To evaluate effect of combined corpeetomy for multilevel cervical spondylotic myelopathy (CSM) and ossified posterior longitudinal ligament (OPLL).Methods Fifteen patients with CSM or OPLL,including 9 males and 6 females,were treated with combined corpectomy which is characterized by C4 and C6 corpectomy,excision of osteophyma,protruded disc and/or ossified posterior longitudinal ligament on basis of preservation of C5 vertebral body,structural bone grafting in C3-5 and C5-7,and anterior cervical plate fixation at C3,C5,and C7.The clinical results were evaluated with Japanese Orthopaedic Association (JOA) score.X-rays and CT scans were taken to evaluate vertebral fusion,and MRI was used to access spinal canal decompression and condition of spinal cord.Results All patients were followed up for 9 to 42 months (average,26.7 months).Bony fusion was achieved in all 15 patients.The JOA score improved from preoperative 13.44±2.81 to postoperative 16.16±2.19 (P=0.0354).The cervical lordosis improved from preoperative 1.16°±11.74° to immediately postoperative 14.36°±7.85° (P=0.00217),and 12.92°+6.17° at the final follow-up (P=0.00292).The complications included temporary hoarseness in 2 cases,dysphagia in 1 case.Conclusion The combined corpectomy for treating CSM and OPLL can obtain reliable and satisfactory results.In operation,the preservation of C5 vertebral body can provide an additional screw anchoring force and strengthen stahility.