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1、颈前路减压内固定治疗脊髓型颈椎病【摘要】目的探讨脊髓型颈椎病颈前路的手术治疗方法及疗效分析。方法对63例脊髓型颈椎病患者行颈前路椎间盘切除减压钛网植骨或自体髂骨植入结合颈前路带锁钢板固定术。术后随访观察颈椎X线片、自我感觉、临床功能评价、神经功能恢复情况。结果63例患者全部获得随访,随访时间12～24个月(平均16个月)。手术后恢复满意,患者生活基本可自理。神经功能改善依据JOA评定标准，优29例,良18例,中10例,无效6例；JOA评分由术前(9.1±2.4)分上升至术后的(17.4±3.2)分。结论应用颈前路减压钛网植骨或自体髂骨植入颈前路
2、带锁钢板内固定术治疗脊髓型颈椎病，具有支撑、稳定手术椎体节段和诱导成骨的优点,术后颈椎即时稳定性好,椎间融合率高。【关键词】前路内固定脊髓型颈椎病手术治疗 【Abstract】ObjectiveToexploretheeffectofsurgicaltreatmentofcervicalspondyloticmyelopathythroughanteriordecompressionandinternalfixationandevaluatethetherapeuticeffects.Methods63casesofcervicalspond
3、yloticmyelopathyweretreatedwithcervicalanteriordecompression,reticulartitaniumimplantorself-iliumorbitalimplantcombinedwithcervicalanteriorinternalfixationwithanteriorlockingcervicalplate.Xray,self-sensation,clicialfunctionalevaluation,functionalrecoveryofnervewereevaluatedd
4、uringfollow-uppostoperatively.ResultsAllthe63patientswerefollowedup,thefollowuptimewas12～24months(16monthsaverage),thepostoperativetreatingeffectsweresatisfactoryandthepatientscouldbebasicallyself-cared.JOAcreteriawasusedtoevaluatethefunctionalrecoveryofnerve:excellentin29ca
5、ses,goodin18cases,mediumin10cases,ineffectivein6cases.JOAscoreimprovedfrom(9.1±2.4)preoperativelyto(17.4±3.2)postoperatively.ConclusionsTreatmentofcervicalanteriordecompression,reticulartitaniumimplantorself-iliumorbitalimplantcombinedwithcervicalanteriorinternalfixationwith
6、anteriorlockingcervicalplatehasthefunctionofsupportingandstablizingthevertebrasegmentsbeingoperated,inducingtheosteogenesis.Theinstantstiffnessofcervicalvertebraisgoodandintervertebralfusionrateishigh. 【Keywords】anteriorinternalinfixationcervicalspondyloticmyelopathysurgica
7、ltreatment 脊髓型颈椎病(cervicalspondyloticmyelopathy，CSM)是颈椎退行性变中最常见的一类疾患,以椎间盘退变为病理基础，此病一经确诊应尽早手术。外科手术原则是直接、彻底去除脊髓致压物,稳定脊椎,重建颈后生理曲度,获得牢固的骨性融合。对于多节段脊髓型颈椎病最早是采用后路减压的方法,自1958年SmithRobinson率先开展颈前路手术以来,相继出现了多种颈前路手术方法,近年来,4颈前路减压植骨融合同时行钛板内固定治疗颈椎病、颈椎骨折已在临床上广泛应用于解除颈椎间前路压迫,已成为脊柱外科的一种标准。随着
8、颈前路手术的广泛开展,术后融合节段高度的丢失、颈椎管再次狭窄等并发症逐渐受到重视。为进一步总结提高脊髓型颈椎病前路手术疗效,减少术后并发症,现对本院2
