曾广吾

[关键词] 脊髓型颈椎病;非手术;外科手术;手术方式;研究进展

[中图分类号] R681.55          [文献标识码] A          [文章编号] 1673-9701（2021）14-0189-04

Progress in treatment of cervical spondylotic myelopathy

ZENG Guangwu

Department of Orthopedics，Guidong People′s Hospital of Guangxi Zhuang Autonomous Region， Wuzhou   543001， China

[Abstract] Cervical spondylotic myelopathy（CSM） is the most serious type of cervical spondylosis， which is caused by the degeneration of the cervical spine and the ensuing long-term compressive deformation of the spinal cord， then leading to spinal cord dysfunction. Once CSM is diagnosed， it is recommended to develop treatment plans as soon as possible， which can be divided into nonsurgical conservative treatment and surgical treatment. Non-surgical intervention has a certain curative effect and should be the most classical， traditional and first choice for early intervention. If conservative treatment fails or progressive neurological dysfunction worsens， surgery should be performed as soon as possible to avoid aggravation of spinal cord injury or even irreversible injury. The surgical treatment aims to relieve spinal cord compression， dilate the spinal canal， restore spinal cord function and restore cervical stability. At present， there are three approaches for surgical treatment for CSM in clinical practice： anterior approach， posterior approach and combined anterior and posterior approach， each of which has its own advantages and disadvantages. Various factors should be considered in the selection of treatment plan， and individualized treatment plan should be adopted.

[Key words] Cervical spondylotic myelopathy; Non-surgery; Surgery; Operation method; Research progress

脊髓型頸椎病（Cervicalspondylotic myelopathy，CSM）是由于颈椎间盘退行性改变及其邻近结构继发炎症肥厚增生等病理改变，导致颈脊髓受压或（和）脊髓血供不良产生脊髓功能障碍的疾病[1]。CSM占全部颈椎病的10%～15%，是最为严重的类型，可严重影响身心健康及生命质量[2]。

CSM的病理生理是脊髓神经组织受压致神经组织缺血、神经细胞损害的过程，起重要作用的因素主要分为静态和动态[3]。最重要静态因素是椎管内容积，椎管狭窄致脊髓受压引起水肿、缺血、变性等造成脊髓功能损害;主要动态因素是椎间盘的退变、颈椎不稳异常运动创伤或炎症刺激，导致局部血管痉挛而造成脊髓缺血功能损害。

CSM临床分型有轻度、中度（轻度伴危险因子）及重度三类，又从发病节段数目将其分为单节段、双节段和多节段脊髓型颈椎病（Multilevel cervical spondylotic myelopathy，MCSM）[4]。

CSM的治疗不单是缓解脊髓神经症状，更重要的是避免脊髓遭受持续的伤害导致不可逆的损害。确诊CSM建议尽早拟定治疗方案，分为非手术治疗和手术治疗。

1 非手术治疗

根据2018年颈椎病的分型、诊断及非手术治疗专家共识[5]，结合CSM的病理特点，保守分为发病急性期及慢性期治疗，急性期以颈部制动并予脱水消肿药物、非甾体类药物、营养神经药物、骨骼肌松弛类药物、传统中药等治疗为主;慢性期则以改善微循环、神经营养药物、现代物理理疗以及传统中医推拿、针灸等多疗法的综合治疗[6]。……