CAJ | 학술논문

目的探讨融合兼非融合手术(Hybrid)治疗脊髓型颈椎病疗效、手术要点及适应证.方法 2008年8月至2011年12月采用Hybrid手术治疗脊髓型颈椎病患者38例,男27例,女11例,年龄33～70岁,平均51岁.共86个节段,涉及双节段28例,三节段10例,融合48个节段,非融合38个节段.术前及末次随访采用日本矫形外科协会(Japanese Orthopaedic Association,JOA)评分系统评估神经系统功能；采用疼痛视觉模拟评分(visual analogue scale,VAS)评估疼痛；在颈椎X线片上测量颈椎活动度及人工椎间盘与相邻节段高度；观察手术并发症.结果 38例患者中37例获得随访,随访15～55个月(平均29.1个月).36例患者神经系统功能得到不同程度恢复,JOA评分术前(10.5±1.57)分,末次随访(14.3±1.97)分,改善率为58.46％,优16例,良20例,差1例.VAS评分术前(7.3±1.04)分,末次随访(3.2±1.41)分,颈椎Cobb角由术前25°±3.21°改善至末次随访20°±2.56°.术后l例神经功能未见恢复,2例出现声音嘶哑、饮水呛咳,22例出现咽喉疼痛,3例PCM假体前移.其余病例均未见假体移位、内植物松动及异位骨化等发生.结论 Hybrid手术可以彻底减压病变节段,融合退变严重的节段,保留非融合节段的活动度,使患者颈椎达到稳定,症状明显改善,短期疗效满意,是一种可供选择的治疗方案.
목적 탐토융합겸비융합수술(Hybrid)치료척수형경추병료효、수술요점급괄응증.방법 2008년8월지2011년12월채용Hybrid수술치료척수형경추병환자38례,남27례,녀11례,년령33～70세,평균51세.공86개절단,섭급쌍절단28례,삼절단10례,융합48개절단,비융합38개절단.술전급말차수방채용일본교형외과협회(Japanese Orthopaedic Association,JOA)평분계통평고신경계통공능；채용동통시각모의평분(visual analogue scale,VAS)평고동통；재경추X선편상측량경추활동도급인공추간반여상린절단고도；관찰수술병발증.결과 38례환자중37례획득수방,수방15～55개월(평균29.1개월).36례환자신경계통공능득도불동정도회복,JOA평분술전(10.5±1.57)분,말차수방(14.3±1.97)분,개선솔위58.46％,우16례,량20례,차1례.VAS평분술전(7.3±1.04)분,말차수방(3.2±1.41)분,경추Cobb각유술전25°±3.21°개선지말차수방20°±2.56°.술후l례신경공능미견회복,2례출현성음시아、음수창해,22례출현인후동통,3례PCM가체전이.기여병례균미견가체이위、내식물송동급이위골화등발생.결론 Hybrid수술가이철저감압병변절단,융합퇴변엄중적절단,보류비융합절단적활동도,사환자경추체도은정,증상명현개선,단기료효만의,시일충가공선택적치료방안.
Objective To investigate the clinical efficacy,operative essentials and indications of hybrid spinal fusion surgery for cervical spondylotic myelopathy.Methods From August 2008 to December 2011,thirty-eight patients with cervical spondylotic myelopathy underwent hybrid spinal fusion surgery in our hospital.There were 27 males and 11 females,aged from 33 to 70 years (average,51 years).A total of 86 segments were treated (fusion 48 vs.non-fusion 38).Twenty-eight patients underwent a two-level surgery,and ten patients received a three-level surgery.The Japanese Orthopaedic Association (JOA) score and Visual analogue scale (VAS) were used to evaluate pre-and post-operative neurological function and pain,respectively.The pre-and post-operative range of motion of the cervical spine was measured according to Xrays.Moreover,the surgical complications were recorded and analyzed.Results Thirty-seven patients were followed up for 15 to 55 months (average,29.1 months).The improvement of neurological function was obtained in 36 patients.The JOA score was improved from preoperative 10.5±1.57 to 14.3±1.97 at final follow-up,with an improvement rate of 58.46％,and the results were excellent in 16 cases,fair in 20 cases and poor in 1 case.The VAS was improved from preoperative 7.3±1.04 to 3.2±1.41 at final follow-up.The Cobb angle changed from preoperative 25°±3.21°to 20°±2.56°at final follow-up.After operation,the neurological function was not restored in 1 case; hoarseness and bucking occurred in 2 cases; sore throat occurred in 22 cases; anterior displacement of prosthesis (PCM) occurred in 3 cases.Other patients had no complications,such as displacement,loosening and heterotopic ossification.Conclusion In hybrid spinal fusion surgery,the lesions segments are decompressed fully,the severely degenerative segments are fused,and the motion of the non-fusion segments is reserved.As a result,not only the stability of the cervical spine is achieved,but also an obvious improvement of symptoms and a satisfactory short-term efficacy can be obtained.Therefore,this method is an alternative procedure for cervical spondylosis myelopathy.