CAJ | 학술논문

目的：评价人工颈椎间盘置换联合颈前路融合术治疗多节段脊髓型颈椎病的临床效果。方法采用人工颈椎间盘置换联合颈前路融合治疗18例多节段脊髓型颈椎病患者。根据术前、术后、随访时的颈椎X线片观察人工椎间盘、内固定、植骨融合以及JOA评分改善情况。结果18例均获随访，时间24~60(36±9．6)个月。置换间隙平均活动度术前为13．8°±6．5°，末次随访时为12．5°±5．3°，与术前比较差异无统计学意义(P>0．05)。 JOA评分术前为9．5分±1．5分，术后4个月时为14．2分±2．2分，平均改善率62．7%±11．2%，其中优9例，良5例，可2例，差2例。所有病例内置物无松动、移位及断裂，人工椎间盘位置良好。结论人工颈椎间盘置换联合颈前路融合术治疗多节段脊髓型颈椎病能维持颈椎活动度，减少固定融合节段，同时又减少邻近节段运动负荷。
목적：평개인공경추간반치환연합경전로융합술치료다절단척수형경추병적림상효과。방법채용인공경추간반치환연합경전로융합치료18례다절단척수형경추병환자。근거술전、술후、수방시적경추X선편관찰인공추간반、내고정、식골융합이급JOA평분개선정황。결과18례균획수방，시간24~60(36±9．6)개월。치환간극평균활동도술전위13．8°±6．5°，말차수방시위12．5°±5．3°，여술전비교차이무통계학의의(P>0．05)。 JOA평분술전위9．5분±1．5분，술후4개월시위14．2분±2．2분，평균개선솔62．7%±11．2%，기중우9례，량5례，가2례，차2례。소유병례내치물무송동、이위급단렬，인공추간반위치량호。결론인공경추간반치환연합경전로융합술치료다절단척수형경추병능유지경추활동도，감소고정융합절단，동시우감소린근절단운동부하。
Objective To explore the clinical effects of artificial cervical disc replacement( ACDR) combined with anterior cervical discectomy fusion ( ACDF ) for the treatment of multi-segmental cervical spondylotic myelopathy ( CSM) . Methods 18 cases with multi-segmental CSM which were treated by ACDR combined with ACDF were re-viewed. The stability of artificial disc, internal fixation and bone fusion were evaluated by X-ray films before opera-tive, immediate postoperative and follow-up. The JOA scores was evaluated also at the same time. Results 18 pa-tients were followed up from 24 to 60 months ( averaged 36 ± 9. 6 months) . The range of motion of the replacement segment were 13. 8° ± 6. 5° at preoperative and 12. 5° ± 5. 3° at the final follow-up, and there was no significant difference between them(P>0. 05). The preoperative JOA scores was 9. 5 ± 1. 5, which was improved to 14. 2 ± 2. 2 in 4 months after operation; Preoperative neurological symptoms were obviously alleviated in most patients, and the improvement ratio of JOA was 62. 7% ± 11. 2%. The results were excellent in 9 patients, good in 5, fair in 2 and poor in 2. There were no patient with false of internal fixation, and the position of artificial disc was good. Conclu-sions ACDR combined with ACDF is a good procedure for multi-segmental cervical spondylotic myelopathy, it not only maintain the cervical spine alignment with saving more movement segments,but also reduce the incidence of ad-jacent segment degeneration.