CAJ | 학술논문

目的探讨前路手术治疗4节段脊髓型颈椎病的临床效果及其并发症分析.方法回顾性分析2006年9月至2014年3月接受颈椎前路手术的所有病历资料,其中接受前路手术治疗的4节段脊髓型颈椎病患者32例.采用疼痛视觉模拟评分(visual analogue scale,VAS)评估切口和颈肩肢体疼痛情况,日本骨科协会(Japanese Orthopaedic AssociationScores,JOA)评分评估神经功能.应用颈椎侧位X线片测量颈椎的前凸角度和高度改变,并评估植骨融合情况.对并发症进行统计和分析,包括髂部疼痛、脑脊液漏、喉返神经损伤、C5神经根麻痹、轴性痛、一过性吞咽困难等.结果 32例患者手术均顺利完成,手术时间平均为(136±18) min,失血量平均为(67±16) ml.随访时间1~8年,平均(3.6±1.7)年.颈肩肢体疼痛VAS评分术前平均(7.3±1.2)分,术后12个月平均为(3.6±0.8)分,差异有统计学意义.术前、术后1周、术后3、6及12个月的JOA评分分别平均为(9.2±1.6)分、(9.6±2.2)分、(12.5±3.3)分、(13.2±3.2)分和(13.7±3.4)分.随访期间所有患者的内植物均保持安全、有效,无植入物松动、移位.自体髂骨植骨4例,术后6个月均达到融合标准.应用钛网的28例,24例在术后6个月、4例在术后1年达到融合标准.并发症包括取髂骨处疼痛、不适3例,脑脊液漏2例,喉返神经损伤1例,C5神经根麻痹1例、轴性痛5例、一过性吞咽困难1例.结论以脊髓前方受压为主的4节段脊髓型颈椎病应用前路手术治疗,根据压迫部位的不同采用不同的椎体次全切除方式,最常用的是C4、C6椎体次全切除+2个钛网植骨+钢板内固定术.只要减压、重建、固定等环节做到精确到位,可获得满意的临床疗效.
목적 탐토전로수술치료4절단척수형경추병적림상효과급기병발증분석.방법 회고성분석2006년9월지2014년3월접수경추전로수술적소유병력자료,기중접수전로수술치료적4절단척수형경추병환자32례.채용동통시각모의평분(visual analogue scale,VAS)평고절구화경견지체동통정황,일본골과협회(Japanese Orthopaedic AssociationScores,JOA)평분평고신경공능.응용경추측위X선편측량경추적전철각도화고도개변,병평고식골융합정황.대병발증진행통계화분석,포괄가부동통、뇌척액루、후반신경손상、C5신경근마비、축성통、일과성탄인곤난등.결과 32례환자수술균순리완성,수술시간평균위(136±18) min,실혈량평균위(67±16) ml.수방시간1~8년,평균(3.6±1.7)년.경견지체동통VAS평분술전평균(7.3±1.2)분,술후12개월평균위(3.6±0.8)분,차이유통계학의의.술전、술후1주、술후3、6급12개월적JOA평분분별평균위(9.2±1.6)분、(9.6±2.2)분、(12.5±3.3)분、(13.2±3.2)분화(13.7±3.4)분.수방기간소유환자적내식물균보지안전、유효,무식입물송동、이위.자체가골식골4례,술후6개월균체도융합표준.응용태망적28례,24례재술후6개월、4례재술후1년체도융합표준.병발증포괄취가골처동통、불괄3례,뇌척액루2례,후반신경손상1례,C5신경근마비1례、축성통5례、일과성탄인곤난1례.결론 이척수전방수압위주적4절단척수형경추병응용전로수술치료,근거압박부위적불동채용불동적추체차전절제방식,최상용적시C4、C6추체차전절제+2개태망식골+강판내고정술.지요감압、중건、고정등배절주도정학도위,가획득만의적림상료효.
Objective To investigate the clinical results, neurological scores, radiographic changes and complications for patients with 4-level cervical spondylotic myelopathy (4-level CSM) who underwent anterior decompression and fusion surgery.Methods All the medical records of anterior cervical surgery in our hospital between September 2006 and March 2014 were collected.Among them, thirty-two consecutive patients with 4-level CSM underwent the anterior decompression and fusion procedures were retrospectively investigated.Neurological function was measured at different times using Japanese Orthopedic Association (JOA) scores.The visual analogue score (VAS) was recorded for neck-shoulder pain evaluation.X-rays were conducted before and after surgery for cervical lordosis and fusion rate.Complications such as iliac pain, dysphonia, C5 palsy, cerebral fluid leakage, axial neck pain and temporary dysphagia were recorded and analyzed as well.Results All the operations were performed uneventfully.The mean operative time was 136± 18min and mean blood loss was 67±16ml.The overall follow-up period of the patients ranged from 1-8 years (average 3.6± 1.7years).The VAS score significantly decreased from 7.3± 1.2 preoperatively to 3.6±0.8 at 12 months postoperatively.The JOA score was 9.2± 1.6 preoperatively, and 9.6±2.2, 12.5±3.3, 13.2±3.2, 13.7±3.4 at 1 week, 3 months, 6 months and 12 months postoperatively.Autologous iliac bone grafts were used in 4 patients, whose fusion rate was 100％ at 6 months postoperatively.Titanium meshes were used in 28 patients, whose fusion rate was 85.7％ at 6 months postoperatively and 100％ at 12 months postoperatively.No hardware-related complications such as screw pull-out or plate bending occurred during the short-or long-term follow-up.Complications included iliac pain (3 cases), dysphonia (1 case), C5 palsy (1 case), cerebral fluid leakage (2 cases), axial neck pain (5 cases) and temporary dysphagia (1 case).Conclusion Anterior approach for 4 -level CSM is a challenging surgical technique.The choice of corpectomy levels should depend on the characteristics of cord compression.C4 and C6 discontinuous corpectomy with titanium mesh graft fusion and plate fixation is recommended procedure.This technique will be safe and effective if proper decompression and steady fixation are guaranteed.