重症脊髓型颈椎病前、后路联合手术治疗次序的选择

Selection of combined posterior-anterior approach procedure for severe cervical spondylotic myelopathy

目的:探讨前、后路联合手术治疗重症脊髓型颈椎病手术次序选择的原则。方法:回顾性分析45例重症脊髓型颈椎病患者,男27例,女18例,先行颈椎前路减压再行后路椎管扩大成形手术19例(A组),先行颈椎后路椎管扩大成形再行前路减压融合手术26例(B组)。术前、术后均采用JOA评分法进行评分,根据JOA评分改善率评价两组治疗效果的优良率。结果:术中A组1例因前路手术使椎管前方骨化组织进一步挤压脊髓组织致患者截瘫;2例因前路手术致压物切除不彻底,术后患者症状无明显改善。B组1例术后出现C5脊神经根麻痹,颈椎前路减压后逐渐恢复。术后随访9￣38个月,平均20.4个月。两组优良率分别为69.23%(B组)、42.10%(A组),B组患者手术治疗效果明显优于A组。结论:前后路联合手术治疗重症脊髓型颈椎病应先行后路椎管扩大成形再行前路减压融合,手术效果较好,并发症少,安全性高。

Objective：To explore the principle of combined posterior-anterior approach procedure for severe cervical spondylotic myelopathy.Method：45 patients（27 males and 18 females） with severe cervical spondylotic myelopathy treated surgically were included in this study.There were 19 cases in group A （anterior compression followed by posterior cervical laminoplasty） and 26 cases in group B （anterior compression following posterior cervical laminoplasty）.Eaeh patient was evaluated by pre-operative and post-operative JOA score. Result：All the patients were followed-up for 9-38 months,with an average of 20.4 months.The excellent and good rate was 42.10% in group A and 69.23% in group B.The surgical outcome of group B was much better than group A （P〈0.05）.Condusion：Anterior decompression following posterior cervical laminoplasty intreating severe spondylotic myelopathy can ensure good outcome.