脊髓型颈椎病：循证医学综述.doc

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1、请多指教！CervicalSpondyloticMyelopathy:AReviewoftheEvidence脊髓型颈椎病：循证医学EricKlineberg,MDCervicalspondyloticmyelopathy(CSM)isthemost8mmonprogressivespinalcorddisorderinpatientsmorethan55yearsold.Morethan50%ofmiddle-agedpatientsshowradiographicevidenceofcervicaldisease,butonly10%hav

2、eclinicallysignificantrootorcordcompression.CSMisalsothemostcommoncauseofacquiredspasticityinlaterlifeandmayleadtoprogressivespasticityandneurologicdecline.1Therearemultiplesymptomsofmyelopathy,includingmotorandsensorydisturbsnces,buttheonsetisusuallyinsidious・Lowerextremiti

3、esareaffectedfirst,andpatientscancomplainofgaitdisturbance,withdegenerationofthespinocerebellarandcortico-spinaltracts.Theupperextremitiescanthenbecomeaffectedwithlossofcoordinationanddifficultywithfinemotortasks.2However,thesymptomscanbemuchmoresubtleandmayinvolveaxialneckp

4、ain,scapularpain,oraprogres-sivebroad-basedgait・Often,thepatienfsspousenoticesthedisturbanceearliestasanunfamiliarwalkingpattern.在55岁以上人群中，脊髓型颈椎病是一种导致脊髓进行性病变的最常见疾病。颈稚影像学检杳发现一半以上的中老年患者有影像学改变。而有明显神经根或脊髓压迫症状的只有10%。CSM是导致患者晚年痉挛、进行性麻痹甚至神经功能障碍的最常见原因。颈椎病症状有很多：包括运动和感觉障碍，但人多起病隐匿，首先累及

5、下肢。由丁伴有脊髓小脑或皮质脊髓束的退变，患者常主诉步态不稳。上肢主要表现为协调能力差，粘细动作不能。然而，有时这些症状可能不太明显，有时还合并颈项痛、用胛部疼痛、进行性步态变宽。通常，最早引起患者注意的是步态改变。GOALSThisarticleexploressomeofthecontroversiesinCSMandreviewspertinentarticles,specificallyprospectiveandrandomizedclinicaltrialswhenpossible,toobtainthecleanestandlea

6、stbiaseddata・The4currentcontroversialtopicsthatsurroundCSMare:(1)naturalhistoryofmildCSM;(2)surgicalapproach:anteriorversusposte-rior;(3)laminoplastyorlaminectomy;and(4)cervicalarthroplastyforCSM.日的本文主要探讨关于CSM的争议并进行文献综述,尤其是随机的前瞻性临床实验,以期得到最淸晰和最新的数据资料。主耍讨论针对CSM的以下4个焦点：1、轻度CSM的

7、自然病史；2、乎术入路；前路还是后路；3、稚板成形术还是椎板切除术；4、颈稚间盘置换术。NATURALHISTORYThenaturalhistoryofCSMisnotwellknown.Historicallysurgicaltreatmenthasbeenthemain-stayforprogressiveCSM.Tractionandsoftcollarshavenotbeenshowntoalterthenaturalcourseofthedisease.3Therehavebeenseveralseriesstudyingpatie

8、ntstreatedconservatively,and26%to50%ofpatientsmaydeteriorateneurolog-ically