不同外科术式治疗多节段脊髓型颈椎病的疗效评价

The different surgical procedures for multisegmental cervical spondylotic myelopathy

目的评价不同外科术式在治疗多节段脊髓型颈椎病中的应用和临床疗效。方法对临床收住的经影像学诊断的186例多节段颈椎病患者资料作回顾性分析，主要依靠术式和术前脊髓功能评分，结合术时年龄、性别和病程，将符合标准的87例患者归类为均衡相似的3组，A组35例为颈后路椎管成形术患者；B组31例为颈前路椎体次全切除术患者；C组21例为颈前路多平面环锯减压椎间盘切除术患者。术后疗效利用日本矫形外科学会（JOA）评分标准评定脊髓功能恢复情况，随访各组并发症，并统计分析。结果随访3个月～3年2个月，平均约8个月，各组术后脊髓功能均有不同程度改善，3组优良率分别为65．7％、80．6％和71．4％，术后3组优良率经Chi—square检验无显著差别（χ^2=1．844，P=0．397〉0．05），但B组优良率最高，其并发症例次率也较高（22．3％），主要发生于B组多椎体次全切除术式患者，而该组单椎体次全切除附加椎间盘切除术13例患者并发症较低，仅1例，组内两术式并发症发生率比较有显著差别（P〈0．05）。结论不同术式治疗多节段脊髓型颈椎病均可获得较好临床疗效，单椎体次全切除结合椎间盘切除融合的分节段混合减压术可能是较理想术式，其减压彻底有效且并发症少。

Objective To evaluate the clinical effects of different surgical treatments for multisegmental cervical spondylotic myelopathy （CSM）. Methods Out of the 186 patients with multisegmental CSM,87comparable eases were reviewed and divided into 3 groups. Group A （35 cases） were treated by posterior open- door laminnoplasty; group B （31cases）, by anterior corpectomy; group C （21 cases）, by anterior decompression at different levels and removal of intervertehral disc. The function of the spinal cord and the postoperative complications were followed up. Results The follow- up lasted 3 months to 3 years and 2 months （mean 8 months）. The rate of effectiveness was 65.7% ,80.6% and 71.4% in groups A,B and C respectively （χ^2 = 1.844, P = 0.397 〉 0.05）. Though better improvements were achieved in group B, the relatively high incidence of complications （22.3%） was also there, which mainly occurred after subtotal corpectomy in two or more vertebrae. Conclusion Different surgical procedures for multisegmental CSM can bring about satisfactory clinical effects to different extents. Anterior decompression combined with unisegmental corpectomy and duisc - removal （a hybrid decompression） may be an ideal way for treating multisegmental CSM.