CAJ | 학술논문

背景：对于严重的颈椎间盘突出、后纵韧带钙化、黄韧带增生，实施前后联合入路不仅可以达到彻底减压的目的，同时植入cage及前路钢板矫形固定可部分恢复椎体间隙及颈椎生理曲度。 　　目的：比较颈椎病颈后路单开门椎管扩大成形及增加前路cage融合内固定对治疗后患者颈椎曲度、稳定性及轴性症状发生的影响。 　　方法：回顾性分析颈椎病外科治疗50例患者的临床资料。其中行一期前后联合入路脊髓减压(前路 cage+钢板融合固定)22例(前后路联合治疗组)；单纯行颈后路单开门椎管扩大成形(后路开窗铆钉固定)28例(单纯后路治疗组)。治疗后随访6-24个月，分别对两组治疗后神经功能恢复情况、轴性症状的发生率及颈椎曲度指数、病变节段椎间滑移度进行统计分析。 　　结果与结论：两组患者的神经功能恢复均获得较好的日本骨科学会(JOA)改善率，前后路联合治疗组患者轴性症状的发生率相对低，颈椎曲度指数较单纯后路治疗组患者有较为明显的改善，而单纯后路治疗组椎间滑移度相对较大。结果表明一期前后联合入路使用 cage、前路钢板、后路铆钉行脊髓减压可以有效维持颈椎的生理曲度从而维持矢状面的平衡，减少患者轴性症状的发生率，对维持治疗后颈椎长期的稳定性起到重要作用。
배경：대우엄중적경추간반돌출、후종인대개화、황인대증생，실시전후연합입로불부가이체도철저감압적목적，동시식입cage급전로강판교형고정가부분회복추체간극급경추생리곡도。 　　목적：비교경추병경후로단개문추관확대성형급증가전로cage융합내고정대치료후환자경추곡도、은정성급축성증상발생적영향。 　　방법：회고성분석경추병외과치료50례환자적림상자료。기중행일기전후연합입로척수감압(전로 cage+강판융합고정)22례(전후로연합치료조)；단순행경후로단개문추관확대성형(후로개창류정고정)28례(단순후로치료조)。치료후수방6-24개월，분별대량조치료후신경공능회복정황、축성증상적발생솔급경추곡도지수、병변절단추간활이도진행통계분석。 　　결과여결론：량조환자적신경공능회복균획득교호적일본골과학회(JOA)개선솔，전후로연합치료조환자축성증상적발생솔상대저，경추곡도지수교단순후로치료조환자유교위명현적개선，이단순후로치료조추간활이도상대교대。결과표명일기전후연합입로사용 cage、전로강판、후로류정행척수감압가이유효유지경추적생리곡도종이유지시상면적평형，감소환자축성증상적발생솔，대유지치료후경추장기적은정성기도중요작용。
BACKGROUND:The combination of anterior and posterior approaches for severe cervical intervertebral disk herniation, posterior longitudinal ligament calcification and ligament flava hyperplasia can completely reduce compression. Simultaneously, cage implantation and anterior plate fixation partial y recover vertebral interspace and physiological curvature of cervical vertebra. OBJECTIVE:To compare the effects of cervical posterior single-door laminoplasty for cervical spondylosis and anterior cage-assisted fusion on curvature, stability and axial symptoms after treatment. METHODS:Clinical data of 50 patients, who received surgical treatment for cervical spondylosis, were retrospectively analyzed. 22 cases underwent I-stage spinal decompression by the combination of anterior and posterior approaches (anterior fusion cage+steel plate fixation) (combination group). 28 cases underwent cervical posterior single-door laminoplasty (posterior windowing rivet fixation) (posterior approach group). They were fol owed up for 6 to 24 months. The recovery of neurological function, incidence of axial symptoms, cervical curvature index, and slipping degree of affected intervertebral segments were analyzed statistical y. RESULTS AND CONCLUSION:The neurological functions were greatly improved according to Japanese Orthopaedic Association in both groups. Incidence of axial symptoms was relatively low in the combination group. Cervical curvature index was obviously improved in the combination group compared with the posterior approach group. The slipping degree of affected intervertebral segments was relatively greater in the posterior approach group than that in the combination group. Results suggested that fusion cage, anterior steel plate and posterior rivet for spinal decompression in I-stage combination of anterior and posterior approaches can effectively maintain cervical physiological curvature and the balance of sagittal level, reduce incidence of axial symptoms, and play a key effect on keeping posttreatment long-period cervical stability.