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目的探讨脊髓型颈椎病(cervical spondylotic myelopathy, CSM)前路手术后的远期疗效.方法 随访前路手术后10年以上的CSM患者107例.其中门诊复查36例,均摄颈椎X线正侧位、过伸过屈位片及CT检查;信访71例.另选20例正常人为对照组.结果(1)107例CSM患者前路手术后远期有效率90.7%,优良率81.3%,平均改善率67.9%.(2)门诊复查36例中,颈椎均呈现前凸变浅、变直、后凸等各种畸形.融合节段前方出现不同程度塌陷,融合节段越长,畸形越重.颈椎总运动范围较正常对照组小,但融合区相邻节段运动范围与正常对照组之间差异无显著性意义.(3)颈椎减压融合区骨质再增生导致椎管再狭窄者15例(41.7%).(4)未融合区椎体滑移、出现骨刺、骨桥、椎间盘突出、黄韧带肥厚或钙化者分别为7例(19.4%),18例(50.0%),10例(27.8%),12例(33.3%),7例(19.4%),且均发生于融合区相邻节段,有时涉及上方隔一节段.(5)影像学表现越重,疗效越差,但影像学异常的病例中,仍有38.5%疗效为优.结论 前路手术治疗CSM远期疗效肯定,但颈椎生物力学紊乱可导致融合区前“,”Objective To analyse the long-term results of CSM patients after surgery with anterior approach. Methods One hundred and seven cases of CSM were treated with anterior approach surgery and were followed-up for at least 10 years (10 - 20 years, average 14. 1 years). Among them, 36 were checked with neutral, dynamical X - ray film and CT scan. Twenty normal people were checked with X - ray as control. Results 1) The effective rate was 90. 7%, excellent and good rate was 81. 3%, and mean recovery rate was 67. 9%. 2) Deformation such as straightening or kyphosis were found in 36 patients, and the collapse in anterior part of fused vertebrae was commonly seen. The more vertebrae fused, the more serious deformation occurred. 3) Fifteen patients (41. 7% ) developed stenosis of the canal on the fused vertebral segments. 4) In unfused area, the incidences of spondylolisthesis, spur, bony bridge, hernia of intervertebral discus and hyper plasia of ligament flavum were 19. 4%, 50. 0%, 27. 8%, 33. 3%, 19. 4% respectively, and these always occurred in the adjacent levels. 5) Cases with more abnormalities in radiographic findings often had poorer long-term result. However, there were 10(38. 5%) patients with excellent results bearing abnormal radio graphic findings. Conclusion The long-term result of anterior surgery for CSM is satisfactory. But the dis- order of biomechanics may result in deformation, recurrence of osteophytes on fused vertebrae, and degener- ation in adjacent levels. Some patients who did not deteriorate with radiographic abnormality may be benefited from the elimination of dynamical stenosis of canal and the adaptation of spinal cord.