CAJ | 학술논문

目的:探讨以交感症状为主的颈椎病患者的手术治疗方法和疗效.方法:2003年7月至2007年7月,我科手术治疗18例以交感神经症状为主的颈椎病患者,所有患者术前影像学检查均有颈椎不稳和不同程度的脊髓或神经根受压表现,JOA评分12.4±1.9分,北医三院40分法评分28.7±5.3分.采用前路扩大减压植骨融合术,同时应用内固定重建颈椎稳定性.随访患者JOA评分及北医三院评分改善情况,统计交感神经症状缓解以及并发症发生情况.结果:14例患者采用前路椎间扩大减压植骨融合内固定术,4例采用前路椎体次全切除植骨融合内固定术.术中无血管神经损伤、脑脊液漏等严重并发症发生.6例患者术后有一过性咽喉部疼痛不适,出院时均已消失.随访18～58个月,平均36个月,术后3个月随访时JOA评分和北医三院评分分别为15.2±1.4分和34.3±4.8分,末次随访时分别为15.6±1.0分和35.1±4.4分.两种评分术后3个月和末次随访时与术前相比均存在显著性差异(P<0.05),术后3个月和末次随访时比较无显著性差异(P>0.05).术后交感症状缓解优7例,良10例,差1例.随访时影像学检查显示植骨融合满意,没有颈椎不稳定.结论:颈前路手术充分减压、重建颈椎生理曲度和稳定性治疗以交感神经症状为主的颈椎病可获得满意疗效.
목적:탐토이교감증상위주적경추병환자적수술치료방법화료효.방법:2003년7월지2007년7월,아과수술치료18례이교감신경증상위주적경추병환자,소유환자술전영상학검사균유경추불은화불동정도적척수혹신경근수압표현,JOA평분12.4±1.9분,북의삼원40분법평분28.7±5.3분.채용전로확대감압식골융합술,동시응용내고정중건경추은정성.수방환자JOA평분급북의삼원평분개선정황,통계교감신경증상완해이급병발증발생정황.결과:14례환자채용전로추간확대감압식골융합내고정술,4례채용전로추체차전절제식골융합내고정술.술중무혈관신경손상、뇌척액루등엄중병발증발생.6례환자술후유일과성인후부동통불괄,출원시균이소실.수방18～58개월,평균36개월,술후3개월수방시JOA평분화북의삼원평분분별위15.2±1.4분화34.3±4.8분,말차수방시분별위15.6±1.0분화35.1±4.4분.량충평분술후3개월화말차수방시여술전상비균존재현저성차이(P<0.05),술후3개월화말차수방시비교무현저성차이(P>0.05).술후교감증상완해우7례,량10례,차1례.수방시영상학검사현시식골융합만의,몰유경추불은정.결론:경전로수술충분감압、중건경추생리곡도화은정성치료이교감신경증상위주적경추병가획득만의료효.
Objective: To investigate the method and result of surgical treatment for cervical spondylosis pa-tients with sympathetic symptoms.Method:18 cases of cervical spondylosis with sympathetic symptoms treated by operation in our department between July 2003 and July 2007 were analyzed retrospectively.Imaging exam-inations demonstrated that all cases had cervical instability and spinal cord or nerve root compression to some extent.The preoperative JOA scores and Peking University Third Hospital (PUTH) scores were 12.4±1.9 and 28.7±5.3 accordingly.They were treated with extensive anterior decompression,bone graft fusion with plate and screw fixation to reconstruct cervical spine stabihty.The improvement of JOA and PUTH scores were analyzed during followi-up.The excellent rate of relieving of sympathetic symptoms and surgical compheations were also analyzed.Result:14 cases were treated with extensive anterior intervertebral decompression,bene graft fusion with internal fixation and other 4 cases were treated with anterior corpectomy,bone graft fusion with internal fixations.No severe complications such as neurovascular injury and cerebrospinal fluid leakage were observed during the operation.6 patients experienced transient pain and discomfort of throat after the surgery,which disappeared before discharge.The mean time of fellow-up was 36 months(18-58 months) .The JOA and PUTH scores were 15.2±1.4 and 34.3±4.8 at three months of interview after operation and 15.6±1.0 and 35.1±4.4 at last follow-up respectively.Both evaluating systems showed obvious statistical differences between preoperative and either of two postoperative scores(P<0.O5),but both systems showed no statistical differences between two postoperative scores (P>0.O5 ).The results of sympathetic symptom relief were excellent in 7 cases and good in 10 cases.Radiographic findings during following-up showed a satisfactory bone graft fusion without cervical instability.Conclusion:Extensive anterior decompression and reconstruction of cervical stabihty and physiologi-cal curvature is an effective surgical procedure for the treatment of cervical spondylosis with sympathetic symptoms.