摘要目的 探讨颈椎前路手术治疗重度颈椎后凸畸形的治疗效果、安全性和有效性.方法 回顾性分析2008年6月至2016年5月于第二军医大学长征医院脊柱外科就诊并接受前路手术治疗的29例重度颈椎后凸畸形(Cobb角＞50°)患者的临床资料,其中男性19例,女性10例,年龄14～53岁,平均年龄32.6岁;12例为医源性后凸畸形,其中11例曾行颈椎后路椎板切除术,1例颈椎前路术后支撑塌陷;8例为特发性后凸畸形;5例为神经纤维瘤病性后凸畸形;4例为颈椎感染性后凸畸形.所有患者均接受颈椎前路手术,在矢状位X线片上测量C2～7的Cobb角、后凸节段Cobb角、后凸累及椎体数、后凸顶点位置、C2～7矢状面垂直轴(SVA)及T1倾斜角.采用方差分析比较手术前后各参数的变化,计算颈椎后凸指数(KI)和矫形率;比较手术前、后日本骨科协会评估治疗分数(JOA)、视觉模拟评分(VAS)及颈椎功能障碍指数(NDI)的评分结果.结果 29例患者的后凸平均累及4.7个椎体,平均牵引6.3d,手术时间95～ 260 min,平均155 min;出血量120～460 ml,平均135 ml.C2～7的Cobb角术前平均46.6°±18.1°,术后平均11.4°±6.4°;矫形节段Cobb角术前平均72.9°±19.6°,术后平均11.2°±6.4°,平均矫形率84.6％;C2～7SVA术前平均(3.8±14.6) mm,术后平均(12.6±7.8)mm;T1倾斜角术前平均-10.6°±16.4°,术后平均7.1°±14.9°.手术前后C2～7的Cobb角、矫形节段Cobb角、KI、C2～7 SVA及T1倾斜角差异均有统计学意义(F=12.700 ～ 218.200,P值均＜0.01),手术前后的JOA、VAS及NDI评分差异有统计学意义(F=225.500、217.900、131.200,P值均＜0.01).结论 单纯颈椎前路手术可以较为安全有效地治疗重度颈椎后凸畸形,可达到良好的减压效果.

abstractsObjective To determine the feasibility and safety of anterior cervical decompression and fusion in severe cervical kyphosis treatment.Methods Totally 29 patients with sevcrc cervical kyphosis (Cobb angle＞50°) underwent anterior cervical decompression and fusion from June 2008 to May 2016 were studied retrospectively.There were 19 males and 10 females.The average age was 32.6 years ranging from 14 to 53 years.According to the etiology,12 patients had iatrogenic deformity (11 had post-laminectomy cervical kyphosis,1 had kyphosis due to anterior graft subsidence),5 had neurofibromatosis,4 had infective kyphosis,8 had idiopathic cervical kyphosis.The curvature of cervical angle was measured by two-line Cobb method.The severity of cervical kyphosis was evaluated by kyphosis index (KI).Parameters including kyphosis levels,the apex of the kyphosis,C2-7 sagittal vertical axis(SVA) and T1 slope were also measured on lateral radiographs in the neutral position in each patient.The pre-and post-operative Japanese Orthopaedic Association(JOA) scores,visual analogue scale (VAS) of neck pain,neck disability index (NDI) and cervical alignment were compared.All patients were treated by skull traction.Motor evoked potential and somatosensory evoked potential were applied intraoperation as the spinal cord monitor.Results Skull traction was performed for an average of 6.3 days.The mean vertebral number in kyphotic region was 4.7.The average operation time was 155 minutes and blood loss was 135 ml.The preoperative C2-7 Cobb angle was 46.6°± 18.1 ° in average.It was reduced to 11.4° ±6.4° in average after operation.The Cobb angle of operation region was 72.9°± 19.6° in average before operation.It was reduced to 11.2° ±6.4° in average after operation.The kyphosis region correction rate was 84.6％.The mean preoperative C2-7SVA changed from (3.8 ± 14.6)mm to (12.6 ± 7.8) mm postoperatively.The mean preoperative T1 slope changed from-10.6°± 16.4° to 7.1°± 14.9° postoperatively.The average postoperative C2-7 Cobb angle,Cobb angle of kyphosis region,KI,C2-7 SVA and T1 slope changed significantly compared with preoperation (F=12.700-218.200,all P＜0.01).The average postoperative JOA,VAS and NDI scores improved significantly compared with preoperation (F=225.500,217.900,t31.200,all P＜0.01).Conclusion For severe cervical kyphosis,anterior correction is a safe and effective technique,sufficient decompression will be achieved.