CAJ | 학술논문

目的：探讨一期后前联合入路治疗老年人脊髓型颈椎病的疗效。方法2008年1月至2011年1月，我科接受一期后前联合入路治疗脊髓型颈椎病的老年患者35例进行回顾性分析，采用日本矫形协会(JOA)评分及Nurcik分级对患者手术前后神经功能进行评价。后路手术均采用单开门椎管扩大成形术，前路手术采用椎间盘摘除Cage植骨融合术或椎体次全切钛笼植骨融合术。结果35例随访6～36个月，平均18个月。椎体次全切8例，单间隙椎间盘摘除Cage植骨融合术17例，2个间隙椎间盘摘除CAGE植骨融合术10例。手术历时180～300min，平均245min。出血100～1600ml，平均505ml。术前JOA评分(9.34±2.40)分，术后(13.11±1.90)分，平均改善率为47%，二者间差异有统计学意义(P＜0.05)。Nurcik分级，除1例术后仍为V级外，其余均有I～III级的提高。前路植骨均在术后4～9个月融合，未见假体移位、下沉；25例随访时进行了CT复查，未见后路再关门；30例术后进行了颈椎MRI检查，显示脊髓减压充分。术后发生吞咽时疼痛8例，一过性神经功能障碍3例，声音嘶哑1例，深静脉血栓1例，后路切口感染1例。结论脊髓型颈椎病的老年患者常合并较多的系统性疾病，术后并发症较多。一期后前联合入路是治疗老年人脊髓型颈椎病的有效术式。
목적：탐토일기후전연합입로치료노년인척수형경추병적료효。방법2008년1월지2011년1월，아과접수일기후전연합입로치료척수형경추병적노년환자35례진행회고성분석，채용일본교형협회(JOA)평분급Nurcik분급대환자수술전후신경공능진행평개。후로수술균채용단개문추관확대성형술，전로수술채용추간반적제Cage식골융합술혹추체차전절태롱식골융합술。결과35례수방6～36개월，평균18개월。추체차전절8례，단간극추간반적제Cage식골융합술17례，2개간극추간반적제CAGE식골융합술10례。수술력시180～300min，평균245min。출혈100～1600ml，평균505ml。술전JOA평분(9.34±2.40)분，술후(13.11±1.90)분，평균개선솔위47%，이자간차이유통계학의의(P＜0.05)。Nurcik분급，제1례술후잉위V급외，기여균유I～III급적제고。전로식골균재술후4～9개월융합，미견가체이위、하침；25례수방시진행료CT복사，미견후로재관문；30례술후진행료경추MRI검사，현시척수감압충분。술후발생탄인시동통8례，일과성신경공능장애3례，성음시아1례，심정맥혈전1례，후로절구감염1례。결론척수형경추병적노년환자상합병교다적계통성질병，술후병발증교다。일기후전연합입로시치료노년인척수형경추병적유효술식。
Objective To investigate the curative effects of one-stage combined posteroanterior approach for cervical spondylotic myelopathy ( CSM ) in elderly patients. Methods The data of 35 elderly patients who underwent one-stage combined posteroanterior approach for CSM in our institute from January 2008 to January 2011 were retrospectively analyzed. The Japanese Orthopedic Association ( JOA ) score and Nurick grading were employed to evaluate the neurological status of patients before and after the surgery. Single open-door laminoplasty was used in the posterior approach, and meanwhile interbody fusion with cage after discectomy or with titanium mesh cage after corpectomy were used in the anterior approach. Results All 35 patients were followed up for a mean duration of 18 months. Corpectomy was performed in 8 cases, interbody fusion with cage after single-segment discectomy in 17 cases and interbody fusion with cage after double-segment discectomy in 10 cases. The mean duration of operation was 245 min ( range;180-300 min ). The amount of blood loss was 505 ml on average ( range;100-1600 ml ). The JOA scores were ( 9.34±2.40 ) points and ( 13.11±1.90 ) points before and after the surgery respectively, and the mean improvement rate was 47%, with statistical differences between them. Except for 1 patient of grade V according to the Nurick grading system, all other patients had an improvement from grade I to grade III. Anterior interbody fusion occurred in all cases in 4-9 months postoperatively, without displacement or subsidence of the prostheses. The CT reexamination was performed in 25 cases during the follow-up, which revealed that no posterior reclosing occurred. And the cervical MRI was performed in 30 cases postoperatively, which showed that the spine cord was decompressed thoroughly. The postoperative complications were odynophagia in 8 cases, transient neurological deifcits in 3 cases, hoarseness in 1 case, deep venous thrombosis in 1 case and posterior incision infection in 1 case. Conclusions Elderly patients with CSM usually have many systemic diseases and a lot of postoperative complications. One-stage combined posteroanterior approach for CSM in elderly patients is an effective surgical method.