目的:探讨前路减压融合术治疗多节段脊髓型颈椎病的临床疗效.方法:对2006年9月至2012年9月手术治疗的85例多节段脊髓型颈椎病患者进行回顾性分析,其中男48例,女37例；年龄34 ～86岁,平均(54.5±7.5)岁.手术方式包括前路椎间盘切除减压植骨融合术(19例),前路椎体次全切除植骨融合术(45例),前路椎间盘切除联合椎体次全切除减压植骨融合术(21例).术后3d及随访期间均行X线片评估融合情况,比较分析手术前后JOA评分及改善率.结果:85例患者获得随访,时间6～30个月,平均18个月.术中减压彻底,术后获得良好的椎间间隙高度及颈椎曲度.随访期内复查X线片显示3例不融合,融合率为96％.患者术后末次随访JOA评分均高于术前,差异有统计学意义(P＜0.05).根据JOA改善率,疗效评定为:优56例,良16例,有效9例,无效4例.结论:脊髓型颈椎病选择何种术式仍存在争议,根据患者术前症状、体征、影像学检查等合理选择不同的手术方式在减压、恢复椎间高度及颈椎曲度、提高融合率等方面均能取得良好的临床效果.%Objective:To explore clinical effects of multi-segmental cervical spondylosis myelopathy through anterior approach by surgical treatment.Methods:From September 2006 to September 2012,the data of 85 patients with multi segmental cervical spondylosis myelopathy were retrospectively analyzed.Among them,48 cases were male,37 cases were female,ranging the age from 34 to 86 years old (mean,54.5 years old).Surgical procedure included anterior discectomy and fusion (19 cases),anterior secondary discectomy and fusion (45 cases) and anterior discectomy combined with anterior cervical corpectomy with fusion (21 cases).Bone fusion were evaluated by X-ray at the 3rd day after operation and following up.JOA score and improvement rate were compared.Results:All patients were followed up from 6 to 30 months with an average of 18 months.Decompression were done throughly during operation and good intervertebral space height and cervical curvature were obtained.X-ray showed nonunion in 3 cases,and improvement rate was 96％.JOA score after operation was higher than before operation,and had significant differences (P＜0.05).Fifty-six cases got excellent results,16 moderate,9 effective and 4 invalid according to JOA scores.Conclusion:Surgical procedures for cervical spondylosis myelopathy should be chosen reasonably in accordance with sympotoms,signs,imaging data,so as to obtain good results in decompression,recoving intervertebral height and cervical curature,improving fusion rate.
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