摘要:
Objective To explore the clinical effect and safety of square hook knife in the resection of the longitudinal ligament after anterior decompression surgery of cervical spondylosis. Methods The clinical data of 43 cases of cervical spondylosis with square hook knife assisted cervical longitudinal ligament resection in the Department of Orthopedics of Luoyang Orthopedic Hospital of Henan Province from September 2015 to June 2017 were analyzed retrospectively. There were 23 males and 20 females with an age of 38 - 69 ( 54. 2 ± 8. 3 ) years. According to the classification of cervical spondylosis, there were 13 patients of nerve root type, 21 patients of spinal cord type and 9 patients of mixed type. The safety, postoperative efficacy and complications of this method were also analyzed. The operative time, intraoperative blood loss, postoperative hospital stay and postoperative complications were observed. According to the Japanese Orthopaedic Association( JOA) score at the last follow-up, the improvement rate of cervical spinal cord function was calculated to evaluate the clinical efficacy. Results All patients have a smooth operation and 2 patients with cerebrospinal fluid leakage were recovered after conservative treatment. The operative time was 67 -170 (102. 4 ± 20. 7) minutes, the intraoperative blood loss was 50 -280 (160. 6 ± 51. 2) mL, and the postoperative hospital stay was 5-11 (7. 8 ± 1. 3) days. Of the 43 patients, 38 were followed up for 8-17 (10. 5 ± 2. 1) months. No postoperative hoarseness, hematoma, infection, failure of internal fixation and other complications occurred. The preoperative JOA scores were 6-11(8. 7 ± 1. 3 ) points, and the JOA scores were 10 - 17 ( 15. 6 ± 1. 1 ) points at the end of follow-up. The improvement rates of cervical spinal cord function were 65. 8% -93. 6%(83. 1% ± 6. 8%). The curative effects were excellent in 8 patients, good in 24 patients, common in 5 patients and poor in 1 case, with an excellent rate of 84. 2%. Conclusions It is safe and reliable to remove the posterior longitudinal ligament with square hook knife in anterior cervical approach, which is beneficial to the recovery of spinal cord shape and nerve function, and the clinical effect is satisfactory.%目的 探讨自制方形钩刀在颈椎病前路减压术中切除后纵韧带的应用效果及安全性.方法 回顾性分析2015年9月—2017年6月河南省洛阳正骨医院骨科采用方形钩刀辅助后纵韧带切除减压治疗的43例颈椎病患者的临床资料.其中男23例,女20例;年龄38~69(54.2±8.3)岁;神经根型13例,脊髓型21例,混合型9例.患者采用自制方形钩刀辅助行后纵韧带切除术.观察手术时间、术中出血量及术后住院时间、术后并发症发生情况;根据末次随访时日本骨科学会(JOA)评分,计算颈髓功能改善率评定临床疗效.结果 所有患者顺利完成手术,2例患者术中并发脑脊液漏,保守治疗后痊愈.手术时间67~170(102.4±20.7)min,术中出血量50~280(160.6±51.2)mL,术后住院时间5~11(7.8±1.3)d.43例患者中38例获随访,随访时间8~17(10.5±2.1)个月.术后患者无声音嘶哑、血肿、感染、内固定失败等并发症发生.术前JOA评分6~11(8.7±1.3)分,术后末次随访JOA评分10~17(15.6±1.1)分.颈髓功能改善率65.8% ~93.6%(83.1% ±6.8%).疗效评定:优8例,良24例,可5例,差1例,优良率84.2%.结论 颈椎病前路减压方形钩刀辅助后纵韧带切除安全可靠、减压彻底,利于脊髓形态和神经功能恢复,临床疗效满意.