两种不同手术方法治疗多节段受累脊髓型颈椎病的效果研究

Study on the effect of two different surgical methods in the treatment of multi segment cervical spondylosis myelopathy

目的：对比分析两种手术方法治疗多节段受累脊髓型颈椎病的临床效果。方法回顾性分析2011年6月至2015年6月收治的86例多节段受累脊髓型颈椎病患者资料，其中行前路椎体次全切除减压植骨融合术48例，纳入本次研究的 A 组，行后路单开门椎管成形术38例纳入 B 组，比较两组患者术中情况以及术前、术后6个月、末次随访状态评价患者神经功能指标变化情况。结果两组患者术后6个月 JOA 评分明显高于手术前评分，且差异有统计学意义（tA ＝－6．438，tB ＝－7．425，P ＜0．05），两组患者术后6个月及末次随访时 JOA 评分间比较差异无统计学意义（t 术后6个月＝－0．892，t 末次随访＝0．160，P ＞0．05）；末次随访时，A 组优良率为70．83％，B 组为71．05％，两组间比较差异无统计学意义（χ2＝0．00，P ＞0．05）；两组患者均顺利完成手术，A 组平均手术时间为（148．75±40．68）min，B 组为（109．34±35．61）min，组间比较差异有统计学意义（t ＝4．711，P ＜0．05）；A 组术中出血量为（157．82±51．40）mL，B 组为（235．76±61．55）mL，组间比较差异有统计学意义（t ＝－6．399，P ＜0．05）。结论前路椎体次全切除减压植骨融合术与后路单开门椎管成形术治疗多节段受累脊髓型颈椎病均可获得满意的神经功能改善，根据患者的临床症状及合并症制定出合理的手术方案是治疗的关键。

Objective To compare and analyze the clinical effects of two surgical methods in the treatment of multilevel cervical myelopathy.Methods The data of 86 patients with multilevel cervical spondylosis myelopathy were retrospectively analyzed from June 2011 to June 2015.48 patients treated with anterior decompression and bone graft fusion were set as A group.38 patients underwent posterior single open -door laminoplasty were set as B group. The changes of nerve function indexes were compared between the two groups before operation,6 months after opera-tion and the last follow -up.Results 6 months after operation,the JOA score of the two groups was significantly higher than before the operation,and the difference was statistically significant（tA =-6.438,tB =-7.425,P 〈0.05）.After 6 months and the last follow -up,there was no significant difference in the JOA score between the two groups（tafter 6 months =-0.892,tlast fol ow -up =0.160,P 〉0.05）.At the last follow -up,the excellent and good rate of A group was 70.83%,that of B group was 71.05%,and there was no significant difference between the two groups （χ2 =0.00,P 〉0.05）.Two groups of patients were successfully completed surgery,the average operation time of A group was （148.75 ±40.68）min,that of B group was （109.34 ±35.61）min,the difference between the two groups was statistically significant（t =4.711,P 〈0.05）.The amount of bleeding in A group was （157.82 ±51.40）mL,that of B group was （235.76 ±61.55）mL,the difference was statistically significant（t =-6.399,P 〈0.05）.Conclusion Anterior subtotal decompression and bone graft fusion and posterior single open door surgery in the treatment of multi segment cervical spondylosis myelopathy can obtain satisfactory neurological function.According to the patients＇clini-cal symptoms and complications to develop a reasonable surgical plan is the key to treatment.