作　　者： (孟令志）; (王琪）; (刘军）; (项良碧）;

机构地区： 沈阳军区总医院骨科,全军重症战伤救治中心,辽宁沈阳110016

出　　处： 《局解手术学杂志》 2017年第9期652-656,共5页

摘　　要： 目的评价跳跃式颈椎前路椎间盘切除减压融合术治疗两节段非连续脊髓型颈椎病的近期疗效。方法回顾分析2014年1月至2016年12月我科34例两节段跳跃式脊髓型颈椎病行颈椎前路椎间盘切除减压融合术患者的手术时间、术中出血量、JOA评分、NDI评分、JOA改善率、节段前凸角度、融合率及末次随访的Odom’s临床疗效评定。结果手术时间92~125 min,平均103.28 min;术中失血约50~150 m L,平均90 m L;术后颈椎侧位X射线示颈椎生理弯曲恢复。所有患者均获得随访,平均6个月。末次随访见植骨融合率94.1%,无CAGE下沉、内固定松动脱落、感染等严重并发症发生。末次随访的JOA评分(14.21±0.732)分,NDI评分(3.26±1.14)分;平均改善率58.62%;节段性前凸角度术前(10.75±1.132)°,术后(15.61±1.312)°,差异具有统计学意义(P<0.05)。根据末次随访时Odom’s临床疗效评定:优21例,良9例,中4例,优良率为88.2%。结论颈椎前路间盘切除减压融合术治疗跳跃式两节段脊髓型颈椎病,能较好恢复颈椎生理曲度和椎间高度且其融合率高,近期临床疗效满意。 Objective To evaluate the clinical and radiological outcomes of skip-level anterior cervical discectomy and fusion（ACDF） for the treatment of two-level noncontiguous cervical spondylotic myelopathy（CSM）. Methods There were 34 patients with two-level noncontiguous CSM underwent skip-level ACDF in our department from January 2014 to December 2016. The clinical outcome including surgery time, intraoperative blood loss, Japanese Orthopaedic Association （JOA） scores, Neck dysfunction index（NDI） , the improvement rate of JOA, segment lordosis,fusion rate and Odom＇ s criteria were evaluted. Results The surgery time was from 92 minutes to 125 minutes,mean operative time 103.28 minutes;the intraoperative blood loss was 50 to 150 mL,with average blood loss of 90 mL. The cervical spine lateral radiographs showed that the cervical physiological curvature had restored. The patients were followed up for average 6 months. The fusion rate of was 94.1% at the lastest follow-up. No cages subside,implant failure or migration and infection occured. The JOA and NDI scores at the lat- est follow-up were（ 14.21 ±0. 732） and （3.26 ± 1.14 ）, respectively, the JOA scores improvement rates was 58.62%. The segmental lordosis before surgery was （ 10.75 ± 1.132 ） °, the one after surgery was （ 15.61 ±1.312 ）°, the difference was significant （ P 〈 0.05 ）. The Odom＇ s criteria at the lastest follow-up showed that excellent in 21 patients ,good in 9 patients and fair in 4 patients, with excellent and good rate of 88.2%. Conclusion Skip-level ACDF can achieve good clinical and radiologieal outcomes including a high fusion rate and well maintainence of spinal curvature and intervertebral height for patients with two-level noncontiguous CSM.

关 键 词： 脊髓型颈椎病 颈椎前路 减压融合术 跳跃式 两节段 非连续