CAJ | 학술논문

目的：探讨老年颈椎病前路多节段减压融合内固定术后的临床疗效，观察其影像学变化。方法2003年1月～2012年12月收治167例多节段颈椎病患者，其中33例获得完整随访的患者资料纳入本次研究。33例患者术前和末次随访时均拍摄颈椎正侧位、过伸过屈位X线片，比较分析手术前后Cobb角和相邻节段活动度（ range of motion， ROM）的变化以及术后颈椎手术节段Cobb角在动力位X线片上的变化。行颈椎日本骨科学会（ Japanese Orthopaedic Association， JOA）评分，分析相邻节段退变骨赘形成情况及其与钛板长度的相关性，并用Epstein标准对手术结果行主观评价。结果33例患者术后Cobb角和相邻节段ROM较术前明显增大。术后颈椎手术节段Cobb角在过屈及过伸位X片上变化不明显。骨赘形成与钛板是否偏长之间无相关性。术后JOA评分较术前明显减少，改善率为66．35％。患者主观评价结果优良率为75．76％。结论应用颈椎前路多节段经椎间隙减压融合内固定术治疗老年颈椎病，能有效改善颈椎手术节段Cobb角，手术疗效良好；术后相邻节段可能退变；部分患者术后相邻节段有骨赘形成，但与钛板是否偏长无关。
목적：탐토노년경추병전로다절단감압융합내고정술후적림상료효，관찰기영상학변화。방법2003년1월～2012년12월수치167례다절단경추병환자，기중33례획득완정수방적환자자료납입본차연구。33례환자술전화말차수방시균박섭경추정측위、과신과굴위X선편，비교분석수술전후Cobb각화상린절단활동도（ range of motion， ROM）적변화이급술후경추수술절단Cobb각재동력위X선편상적변화。행경추일본골과학회（ Japanese Orthopaedic Association， JOA）평분，분석상린절단퇴변골췌형성정황급기여태판장도적상관성，병용Epstein표준대수술결과행주관평개。결과33례환자술후Cobb각화상린절단ROM교술전명현증대。술후경추수술절단Cobb각재과굴급과신위X편상변화불명현。골췌형성여태판시부편장지간무상관성。술후JOA평분교술전명현감소，개선솔위66．35％。환자주관평개결과우량솔위75．76％。결론응용경추전로다절단경추간극감압융합내고정술치료노년경추병，능유효개선경추수술절단Cobb각，수술료효량호；술후상린절단가능퇴변；부분환자술후상린절단유골췌형성，단여태판시부편장무관。
Objective To investigate the clinical efficacy of the multilevel anterior cervical decompression and fusion for cervical disease in elderly , and to observe imaging changes of radiology .Methods From January 2003 to december 2012, 167 patients with multilevel cervical spondylosis were treated by anterior cervical decompression and fusion ( ACDF ) .Of all patients, 33 cases that got complete follow-up were involved in this study .The cervical X-ray films and the cervical Japanese Orthopaedic Association (JOA) scores of all 33 patients before surgery and at the final follow-up were analyzed.The Cobb’s angle of the surgical segment , the range of motion ( ROM) of adjacent segments , and the changes of Cobb ’ s angle in flexion-extension X-ray films were measured .The correlation of degenerative osteophyte formation of adjacent segments with the length of titanium was analyzed , and the subjective evaluation of curative effect by Epstein standard was recorded .Results The postoperative Cobb ’ s angle of surgical segment , and the ROM of adjacent segments increased significantly , compared with those before operation .Postoperative Cobb ’ s angle of surgical segment in flexion and extension on X-rays did not change significantly .There was no correlation between syndesmophyte formation and the length of titanium .Postoperative JOA score was significantly reduced compared with the preoperative JOA score , and the JOA score improvement rate was 66.35%.The excellent rate of subjective evaluation by Epstein is 75.76%.Conclusion Application of ACDF to treat the elderly patients with cervical spondylosis , can effectively improve the Cobb ’ s angle of surgical segment and get good curative effects .After operation, adjacent segment degeneration may appear .Osteophyte formation may occur after operation in some patients, but it has nothing to do with the length of titanium .