颈前路手术治疗脊髓型颈椎病并颈椎外伤所致急性颈髓损伤19例临床分析

目的探讨颈前路椎体次全切并后纵韧带切除减压植骨融合术治疗脊髓型颈椎病并颈椎外伤所导致的急性颈髓损伤的疗效。方法回顾性分析采用颈前路椎体次全切并后纵韧带切除减压植骨融合术治疗的脊髓型颈椎病并颈椎外伤所导致的急性颈髓损伤的19例患者病历资料，对患者外伤前（T1）、外伤后（T2）、术后1周内几）、术后10个月后几）四个时期的颈椎曲度及神经功能评分（JOA）变化进行分析，判断手术疗效。结果所有患者均获得10—24个月随访，平均（15．2±6．7）个月。T1、T2、T3、T4四个时期的颈椎曲度分别为（28．621±1．850）°、（29．326±2．416）°、（38．384±2．611）°、（37．316±2．521）°。T1、T2、T3、T4四个时期的JOA脊髓型颈椎病评分分别为（12．79±1．316）、（4．00±2．082）、（9．68±3．001）、（11．68±3．334）。结论颈前路椎体次全切并后纵韧带切除减压植骨融合术可达到有效减压效果、可重建颈椎曲度，能提供脊髓型颈椎病并颈椎外伤所导致的颈髓损伤有效康复条件；术后积极康复治疗也是改善神经功能的重要方法。

Clinical analysis on 19 cases of anterior cervical surgical treatment of acute cervical spinal cord injury caused by cervical spondylotic myelopathy and cervical trauma

Objective To explore the effect of anterior cervical corpectomy and posterior longitudinal ligament resection and decompression and fusion for the therapeutic in acute cervical spinal cord injury caused by cervical spondylotic myelopathy and cervical trauma. Methods Retrospective analysis was carried out to 19 cases of acute cervical spinal cord injury caused by cervical spondylotic myelopathy and cervical trauma who used anterior cervical corpectomy and posterior longitudinal ligament resection and decompression and fusion for the therapeutic, and analysis of patients before trauma （T1）, post-traumatic （T2）, within 1 week after operation （T3）, 10 months after operation （T4） these four periods about the changes of cervical curvature and neural function （JOA score） were analyzed, then evaluated the operation curative effect. Results All patients were followed up for 10-24 months, averaged （15.2 ± 6.7） months. The cervical curvature at T1, T2, T3, T4 were （28.621 ± 1.850）° , （29.326 ± 2.416）° , （38.384 ± 2.611）° , （37.316 ± 2.521） ° . The JOA score at T1, T2, T3, T4 were （12.79 ± 1.316）, （4.00 ± 2.082）, （9.68± 3.001）, （11.68± 3.334）. Conclusion Anterior cervical corpeetomy and posterior longitudinal ligament resection and decompression and fusion for the therapeutic can achieve effective decompression, reconstruction of cervical curvature, and it can provide effective rehabilitation conditions in cervical spinal cord injury caused by cervical spondylotic myelopathy and cervical trauma. Active postoperative rehabilitation treatment is also an important way to improve nerve function.