金新蒙 刘 杰 吕 枫 田纪伟 王 雷

    (上海交通大学附属第一人民医院骨科，上海200080)

    脊髓型颈椎病合并腰椎管狭窄症的诊断和治疗策略

    金新蒙刘杰吕枫田纪伟王雷*

    (上海交通大学附属第一人民医院骨科，上海200080)

    背景：脊髓型颈椎病合并腰椎管狭窄症较单纯颈椎或单纯腰椎病变诊断难度更高，治疗选择上也存在争议。目的：总结脊髓型颈椎病合并腰椎管狭窄症的诊断和手术治疗经验。方法：回顾性分析2011年1月至2014年1月我院手术治疗的脊髓型颈椎病合并腰椎管狭窄症患者的病例资料。共45例，男21例，女24例，年龄42～73岁，平均59.3岁。仅行颈椎手术20例，仅行腰椎手术7例，颈椎、腰椎都进行手术18例，其中一期手术者4例，二期手术者14例。漏诊3例，误诊1例。比较术前和末次随访的颈椎病和下腰痛的日本骨科学会(JOA)评分、Oswestry功能障碍指数(ODI)，评价临床症状改善情况。结果：45例中有40例获得随访，随访时间6～42个月，平均25个月。颈椎病JOA评分由术前的(9.6±2.5)分升至末次随访时的(14.6±1.7)分，平均改善率为78.4%；下腰痛JOA评分由术前的(13.7±3.9)分升至末次随访时的(22.5±4.5)分，平均改善率为71.3%；ODI由术前的58.1%±23.8%降至末次随访时的22.4%±15.6%。术前JOA评分和ODI与末次随访时比较，差异有统计学意义(P<0.05)。围术期及随访期间未发生严重并发症。结论：加强对脊髓型颈椎病合并腰椎管狭窄症的认识，尤其是详细的病史询问和神经系统的全面查体是避免漏诊、误诊及提高手术效果的关键。手术先后的选择一般是先做临床症状相对较重的，颈腰椎疾病症状并重时先做颈椎手术。对身体健康状况可以耐受并且对生活质量有较高期望值的患者，可选择一期颈腰椎同时手术。

    脊髓型颈椎病；腰椎管狭窄症；诊断；手术治疗

    【Abstract】Background：Compared with single cervical or lumbar disease，the diagnosis and treatment of coexisting cervical spondylotic myelopathy(CSM)and lumbar spinal stenosis(LSS)are difficult and controversial.Objective：To summarize the diagnosis and treatment experience of coexisting CSM and LSS.Methods：A total of 45 patients with coexisting CSM and LSS treated from January 2011 to January 2014 were enrolled in this retrospective study.There were 21 males and 24 females with a mean age of 59.3 years(range 42-73 years).Cervical decompression was performed in 20 patients and lumbar decompression in 7 patients.Simultaneous decompressions were taken in 4 patients and staged decompressions in 14 patients.Missed diagnose occurred in 3 patients and misdiagnosis in one.Clinical outcomes were evaluated using the Japan Orthopaedic Association Score(JOA)for CSM and JOA for low back pain and Oswestry disability Index(ODI).Results Eventually ......