CAJ | 학술논문

目的：总结采用经前路椎体次全切钛笼置入锁定钢板螺丝钉内固定治疗相邻两节段脊髓型颈椎病的临床疗效。方法2010年8月～2012年12月，采用经前路椎体次全切钛笼置入锁定钢板螺丝钉内固定治疗相邻两节段脊髓型颈椎病25例，其中男性18例，女性7例，年龄33～75岁，平均56.5岁。25例患者均伴有不同程度的脊髓压迫症状。次全切的椎体C4、C5有9例，C5、C6有15例，C6、C7有1例。观察手术前后及随访阶段均拍摄颈椎正侧位、颈椎过伸过屈位X片、颈椎MR。了解颈椎病变部位脊髓受压情况、颈椎稳定性及术后颈椎高度、曲度、钛笼钢板螺丝钉位置和颈椎融合情况。对比术前、术后及随访时疼痛视觉模拟评分（VAS）及日本矫形外科协会（JOA）疼痛评分。结果手术时间为（120±30）min，术中出血量为（150±50）ml。术中未出现相关并发症，随访2～24个月，平均12.5个月。神经功能明显改善，JOA评分由术前的（6.2±1.1）分提高到末次随访的（14.3±1.5）分，平均改善率为（82.3±11.4）%；VAS平均分为2.1分，随访期间未发现钛笼移位、螺丝钉松动及病变部位脊髓再受压现象。结论相邻两节段脊髓型颈椎病，经前路椎体次全切钛笼置入锁定钢板螺丝钉内固定，不仅能及时有效解除脊髓神经压迫，而且能迅速恢复颈椎曲度和高度，重建脊椎稳定性，手术时间短、出血少、损伤小，为患者神经功能的康复创造了有利条件，是一种有效的治疗方法。
목적：총결채용경전로추체차전절태롱치입쇄정강판라사정내고정치료상린량절단척수형경추병적림상료효。방법2010년8월～2012년12월，채용경전로추체차전절태롱치입쇄정강판라사정내고정치료상린량절단척수형경추병25례，기중남성18례，녀성7례，년령33～75세，평균56.5세。25례환자균반유불동정도적척수압박증상。차전절적추체C4、C5유9례，C5、C6유15례，C6、C7유1례。관찰수술전후급수방계단균박섭경추정측위、경추과신과굴위X편、경추MR。료해경추병변부위척수수압정황、경추은정성급술후경추고도、곡도、태롱강판라사정위치화경추융합정황。대비술전、술후급수방시동통시각모의평분（VAS）급일본교형외과협회（JOA）동통평분。결과수술시간위（120±30）min，술중출혈량위（150±50）ml。술중미출현상관병발증，수방2～24개월，평균12.5개월。신경공능명현개선，JOA평분유술전적（6.2±1.1）분제고도말차수방적（14.3±1.5）분，평균개선솔위（82.3±11.4）%；VAS평균분위2.1분，수방기간미발현태롱이위、라사정송동급병변부위척수재수압현상。결론상린량절단척수형경추병，경전로추체차전절태롱치입쇄정강판라사정내고정，불부능급시유효해제척수신경압박，이차능신속회복경추곡도화고도，중건척추은정성，수술시간단、출혈소、손상소，위환자신경공능적강복창조료유리조건，시일충유효적치료방법。
Objective To summarize the clinical efficacy of the anterior corpectomy cut with titanium cage and locking plate screw fixation for the treatment of two adjacent cervical spondylotic myelopathy.Method August 2010~December 2012,Anterior corpectomy cut with titanium cage and locking plate screw fixation for the treatment of adjacent two segments cervical spondylotic myelopathy 25 cases,including 18 men and 7 women patients,aged 33~75 years,mean 56.5 years.In 25 patients with varying degrees of symptoms of spinal cord compression. There are 9 cases(C4/C5). There are 15 cases(C5/C6).There are 1 case(C6/C7).Observed lateral cervical spine,cervical hyperextension flexion X-rays and cervical MR, before and after surg ery and follow-up phase,so as to learn spinal cord compression,cervical stability and postoperative cervical height,curvature,titanium cage plate screw position and cervical fusion. Compared preoperative to postoperative and follow-up,pain visual analog scale (VAS) and the Japan Orthopaedics Association (JOA) pain score.Results Operative time (120±30) min,blood loss (150±50)ml.The surgery does not appear related complications.The followed up time are 2~24 months (mean 12.5 months). Nerve function significantly improved.JOA score increased from preoperative 6.2±1.1 to the last follow-up 14.3±1.5,with an average improvement rate was (82.3±11.4)%.VAS average score is 2.1 points.The follow-up period is not found that the titanium cage shift,loose screws and lesion spinal cord compression phenomenon.Conclusion Anterior corpectomy cut with titanium cage and locking plate screw fixation for the treatment of two adjacent segments of cervical spondylotic myelopathy,effectively relieve nerve compression of the spinal cord,quickly restored cervical curvature and height,reconstruction of spinal stability,shorter operative time,less bleeding, and less damage.It has created favorable conditions for the rehabilitation of neurological function in patients,which is an effective treatment method.