超高龄多节段颈椎病患者外科治疗方案的效果对比分析

Comparative effects of ultra-aged patients with multilevel cervical surgical treatment options

目的探讨超高龄多节段颈椎病患者的不同外科治疗方案的效果。方法选取2010年7月至2015年3月四川省眉山市中医院收治的超高龄多节段颈椎病患者80例,将颈前路椎体次全切除融合术(ACCF)和经前路椎间盘切除植骨融合术(ACDF)纳入前路组,将颈后路椎管扩大成形术(PCL)纳入后路组,比较两组患者的临床疗效、术中术后情况及治疗前后的颈椎脊髓损伤评分(JOA评分)、颈椎功能障碍(NDI)指数、生理曲度及颈椎活动度。结果前路组43例,其中优28例(65.12%),良5例(11.63%),可7例(16.28%),差3例(6.98%),优良率为76.74%;后路组37例,其中优24例(64.86%),良3例(8.11%),可6例(16.22%),差4例(10.81%),优良率为72.97%,两组优良率比较差异无统计学意义(P>0.05)。前路组手术时间明显长于后路组(P<0.05),术中出血量、住院时间明显低于后路组(P<0.05),两组患者的症状消失时间差异无统计学意义(P>0.05)。治疗前,两组患者的JOA评分、NDI指数、生理曲度、颈椎活动度差异均无统计学意义(P>0.05)。治疗后,后路组患者的JOA评分、颈椎活动度明显高于前路组,前路组患者的生理曲度明显高于后路组,差异均有统计学意义(P<0.05)。结论超高龄多节段颈椎病的前路、后路手术均能取得良好的临床疗效,但后路手术在改善患者远期颈椎功能方面优势更大。

Objective To investigate the effect of super-aged multilevel cervical spondylosis different surgical treatment options Abstract Objective. Methods Selected July 2010-Uhra-old multilevel cervical spondylosis March 2015 in our hospital 80 ca- ses,the anterior cervical corpectomy and fusion （ACCF） and by anterior diseeetomy and fusion （ACDF） included anterior group, the posterior laminoplasty （PCL） included in the posterior group,the clinical efficacy of two groups were compared,and postopera tive conditions and cervical spinal cord injury rates before and after treatment （JOA score）, cervical Disability index （NDI index）, lordosis and cervical spine. Results Anterior group of 43 cases, including 28 cases of excellent （65. 12%）, 5 cases of good （11.63%） ,7 cases of moderate（16.28%） ,3 cases of poor（6.98%） ,the good, rate was 76.74% ;posterior group 37 cases,including 24 cases of excellent（64.86%）,3 cases of good（8.11%） ,6 cases of moderate（16.22%）,4 cases of poor（10.81%） ,the good rate was 72.97 %. The difference has no statistically significant （P〈0.05） in good rate. Anterior operative time was significantly higher than the posterior group （P〈0.05）, blood loss, hospital stay was significantly lower than the posterior group （P〈0. 05）, the time of symptoms disappeared has no significant difference in two groups（P^0.05）. After treatment, patients in posterior group, the JOA score, cervical activity significantly were higher than the anterior group,lordosis anterior group were significantly higher than the posterior group,the difference was Statistically significant （P〈0.05）. Conclusion Anterior super aged multilevel cervical disease,posterior approach has achieved good clinical efficacy but greater advantage posterior surgery in patients with long-term improvement in the cervical spine function.