C3、4巨大椎间盘突出前后路一期手术治疗.doc

C3、4巨大椎间盘突出前后路一期手术治疗 　【摘要】 探讨C3、4巨大椎间盘突出的治疗方法。［方法］对16例C3、4巨大椎间盘突出施行颈后路单开门减压，同时行颈前入路C3、4椎间减压、植骨融合内固定术，术后观察脊髓继发损伤、植骨融合率、椎间高度维持情况。［结果］16例患者随访平均6个月以上，均未出现脊髓继发损伤，术后脊髓功能明显改善，均获得牢固的骨性融合。按Odom评分标准：非常满意8例（占50％），满意4例（占25％），基本满意4例（占25％），无不满意病例，总有效率100％，优良率75％。［结论］颈前后入路治疗C3、4巨大椎间盘突出只要严格的掌握手术的适应证，遵循手术的操作原则，可以避免喉头水肿、脊髓损伤等并发症，提高减压及植骨融合率，并有效地维持椎间高度，避免了因骨的再吸收造成椎间塌陷引起的继发神经功能损害。因此，该方法在治疗C3、4巨大椎间盘突出方面是一种较理想的治疗方案。 【关键词】 C3、4椎间盘突出 椎体间融合 内固定 Abstract：［Objective］To observe the surgical treatment for the huge disc herniation of C3、4.［Method］Sixteen patients with huge disc herniation of C3、4 were operated upon with combined posterior decompression of expansive opendoor laminoplasty with anterior decompression,bone graft and plate fixation.After operation,neurological findings,height of the interbody space and fusion rate of the space were observed.［Result］All the patients were followed up for an average of more than six months,all of them did not get secondary nerve injuries in operation,neurological function were improved obviously and all the affected interbody space got solid fusion.Based on the standard of Odom,50% of the patients were very good,25 % good,25 % general,and the effective rate was about 100%,excellent rate was about 75%.［Conclusion］The combined posterior with anterior decopression and interbody fusion for treatment of huge disc herniation of C3、4 has advantage of more security in removing the prolapsed disc,improvement of the interbody fusion rate,keeping the height ofinterbody space.This procedure is one of the effective operative methods in the treatment of huge disc herniation of C3、4. Key words:disc herniation of C3、4； interbody fusion,internal fixation 颈椎间盘突出的手术方法较多，单纯的前入路或后入路椎管减压手术有较多报告，均有很好的疗效〔1〕。但对C3、4巨大椎间盘突出，前后同时入路的手术未见有相关的报道。本院自2002年6月~2005年7月，采用联合前后路治疗C3、4巨大椎间盘突出16例，现将治疗方法与结果报告如下。 1 临床资料 1.1 一般资料 本组16例，其中男9例，女7例；年龄36~75岁，平均53.2岁。本组病例均以脊髓损害为主要表现，有躯体束带感，行走不稳或困难，上下肢肌腱反射亢进，肌张力增高，病理征阳性等表现。合并后方受压致椎管狭窄者症状更重。3例有神经根受压表现。全部病例摄颈椎过伸、过屈侧位片，显示颈椎不稳者2例，颈椎生理曲度不良者9例。MRI均可见