【摘要】 目的探讨颈椎翻修术的适应证、手术方式及其临床疗效。方法自1998年4月～2007年12月,对21例颈椎手术后患者进行了翻修手术。翻修手术距离首次手术的时间2～42个月,平均15.3个月。所有病例均出现临床症状,其中表现为放射性颈肩痛16例、颈部活动受限5例,原有的脊髓受压表现加重8例,再次出现新的脊髓压迫症状7例。首次手术的术前诊断包括:下颈椎骨折脱位6例,神经根型颈椎病2例,脊髓型颈椎病9例,颈椎不稳4例。手术方式包括:单纯前路减压加自体髂骨植骨4例,前路减压加颈椎前路钢板固定8例,前路减压加Cage融合2例,前路椎体次全或全切除加内固定3例,后路CerviFix单纯内固定3例,后路双开门减压1例。结果本组术后疗效优良13例(61.9%),好转6例(28.6%),无效及加重各1例(9.5%)。21例术前评分2～14(8.65±0.37)分,术后8～16(14.27±0.69)分,差异有显著性(P<0.01)。植骨于术后3～6个月融合。未出现喉上、喉返神经损伤、气管食管漏、脑脊液漏以及呼吸系统并发症。结论颈椎翻修术式视具体情况而定,术前宜详细制定手术方案,彻底减压与正确的固定是手术成败的关键。更多还原

【Abstract】 Objective To discuss the indications,operative methods and clinic curative effects of the cervical revision surgery.Methods Twenty-one cases of cervical vertebrae post-operation underwent cervical revision operation between April 1998 and September 2007.The time of revision from the first operation was 4 to 28 months with an average 15.3 months.All patients represented clinic symptoms,including scruff pains 16 ones,cervical motion restricted 5 times;the previous spine cord symptoms aggravated 8 ones,new spinal compression 7 ones.The preoperative diagnosis for the first time operation included:lower cervical fracture dislocation 6 cases,cervical spondylotic radiculopathy 2 cases,cervical spondylotic myelopathy 9 cases,cervical instability 4 cases.The operation style consisted of merely anterior cervical decompression plus auto-ilium graft 4 cases,anterior cervical decompression and plate fixation 8 cases,anterior cervical decompression and cage fusion 2 cases,anterior vertebrae part or total resection and internal fixation 3 cases,posterior simple CerviFix fixation 3 cases,double open door depression 1 case.Results All patients were followed up for 6 to 50 months with an average 20.4 months.The postoperative curative effects were 13 cases excellent(61.9%),6 cases good(28.6%),1 case inefficacy and 1 case aggravation.The JOA graded 2～14(8.65±0.37) preoperatively and 8～16(14.27±0.69) postoperatively.There was a significant difference(P<0.01).Twenty-one cases bone graft had fusion after 6 months.There were no complication,which involved laryngeal nerve and laryngeal nerve injury,tracheo-asophageal leak,leakage of cerebrospinal fluid and respiratory system.Conclusion The cervical revision style depends on specific condition.Preoperative proper detail operation schedule,thorough decompression and correct fixation are the key to the success of the revision operation.更多还原