脊髓型颈椎病前路“V”形截骨“Y”形减压融合△

Anterior "V" - shaped osteotomy, "Y" - shaped decompression and fusion for cervical spondylotic myelopathy

摘要:

[目的] 介绍脊髓型颈椎病前路“V”形截骨“Y”形减压融合术（anterior cervical V-osteotomy, Y-decompression andfusion, ACVYF） 的手术技术和初步临床结果。[方法] 充分显露术椎并处理上下椎间隙，在术椎两侧使用超声骨刀沿颈长肌内侧缘外倾30°~40°对术椎进行截骨（截骨深度以椎体矢状径1/2 为宜），完整取出“V”形骨块保存。在截骨基底部开槽，深度达后侧皮质后，使用刮匙和椎板钳向椎体两侧潜行扩大减压范围，呈“Y”形。自椎间隙向上或下切除后纵韧带及致压物进行彻底减压。将“V”形的截骨块原位回植于截骨的“V”形骨槽内，选择合适大小的笼架置入上下间隙，打压至嵌合牢固，带锁钢板固定并锁定。[结果] 所有患者顺利完成手术，术中及术后无严重并发症发生；术后颈椎CT 及MRI 显示致压物切除干净，神经减压彻底。随访时间平均（16.4±3.1） 个月，与术前相比，术后12 个月，患者颈椎JOA 评分[(8.3±1.4) vs (14.8±1.1), P＜0.001]、C2~7 Cobb角[(15.7±2.5)° vs (19.9±1.9)°, P＜0.001] 均显著增加。所有患者均植骨融合良好，未出现骨块位移、置入物松动、断裂等情况。[结论] ACVYF 治疗后纵韧带骨化、椎体后缘骨赘增生以及椎间盘钙化严重、椎间隙明显狭窄等脊髓型颈椎病安全可行。

关键词:脊髓型颈椎病;颈椎前路V”形截骨;“Y”形减压;骨块回植

Abstract:

[Objective] To introduce the surgical techniques and preliminary clinical results of the anterior "V"-shaped osteotomy,"Y"-shape decompression and fusion (ACVYF) for cervical spondylotic myelopathy. [Methods] As the affected segments were fully ex-posed and the upper and lower intervertebral spaces were treated, a "V"-shaped osteotomy was conducted with ultrasonic osteotome on thevertebral body at 30°~40° along the medial margin of the cervical longus muscle, to the depth of 1/2 of the sagittal diameter of the vertebrae,and the "V" -shaped bone blocks were completely removed and preserved. After grooving at the base of the osteotomy to reach the posteriorcortex, curette and laminar forceps were used to sneak to both sides of the vertebral body to expand the decompression area in a "Y" shape.The posterior longitudinal ligaments and compressors are removed from the intervertebral space up or down for complete decompression. The"V" -shaped bone block was re-implanted back into the "V" -shaped bone groove of the osteotomy in situ, and cage frames in appropriatesize was placed into the upper and lower intervertebral space. Finally, the segments were fixed with a locking plate. [Results] All patientshad operation performed successfully without serious complications during and after the operation. Postoperative CT and MRI of the cervicalspine showed that the compressors were removed completely, in other word, the nerve was decompressed completely. Compared with thosepreoperatively, JOA score [(8.3±1.4), (14.8±1.1), P＜0.001], C2~7 Cobb angle [(15.7±2.5), (19.9±1.9), P＜0.001) were significantly improved atthe latest follow-up lasted (16.4±3.1) months on an average. At the last interview, all patients had good bony fusion without bone graft dis-placement, implant loosening or fracture. [Conclusion] ACVYF is safe and feasible in the treatment of cervical spondylotic myelopathy, in-cluding ossification of posterior longitudinal ligament, osteophytic hyperplasia of posterior margin of vertebral body, severe disc calcification,and obvious stenosis of vertebral canal.

Key words:cervical spondylotic myelopathy; anterior cervical ";V";- shaped osteotomy; ";Y";-shaped decompression; bone block reimplantation