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[关于多节段脊髓型颈椎病诊断与治疗的观点]

[Opinions about diagnosis and treatment of multilevel cervical spondylotic myelopathy].

作者信息

Zhou Ying-jie, Chai Xu-bin

出版信息

Zhongguo Gu Shang. 2016 Jun;29(6):561-5.

Abstract

There should be confusion about diagnosis and treatment for multiple segments cervical myelopathy in some respects. The author reviewed the literature and combined with clinical experience, proposed a new classification for cervical myelopathy according to responsibility segment areas, which dividing into single segment,double segments (continues or jumping type), multi-segment (≥ three segments). The responsible segments determination is the premise of diagnosis and also a key to determine surgical decompression segment. Decompression only according to imaging was not desirable, surgical segment should mainly relies on clinical, imaging, electrophysiological and comprehensive analysis to avoid surgery range expansion. Surgical approach and procedures are still the focus and hotspot of cervical myelopathy treatment, and no treatment standards and corresponding guidelines to consult. The author proposes that surgical approach should advocate the individual, and surgical procedure should follow simple instead of complicate, anterior and posterior combined decompression is not necessary in most cases, and anterior and posterior fixation are not need.

摘要

在某些方面,对于多节段颈椎病的诊断和治疗可能存在困惑。作者回顾了文献并结合临床经验,根据责任节段区域提出了一种新的颈椎病分类方法,分为单节段、双节段(连续或跳跃型)、多节段(≥三个节段)。责任节段的确定是诊断的前提,也是确定手术减压节段的关键。仅根据影像学进行减压是不可取的,手术节段应主要依靠临床、影像学、电生理及综合分析,以避免手术范围扩大。手术入路和手术方式仍然是颈椎病治疗的重点和热点,目前尚无治疗标准和相应指南可供参考。作者提出,手术入路应提倡个体化,手术方式应遵循简单而非复杂的原则,大多数情况下无需前后联合减压,也无需前后固定。

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