3种颈前路减压重建术式治疗多节段颈椎病

Clinical effect comparison of three different methods of anterior cervical decompression and reconstruction for the treatment of multi-level cervical myelopathy

[目的]比较颈前路减压3种术式治疗多节段颈椎病的临床疗效及影像学变化。[方法]选择52例由同一组医师行颈前路减压术的连续三间隙病变的多节段颈椎病患者,依据手术方式不同分为:第1组:颈前路多椎体次全切除减压+长钛网植骨融合组(16例);第2组:多椎间隙减压cage植骨融合组(18例);第3组:钛网与cage组合使用组(18例)。t检验比较3组之间椎间高度变化、方差分析法比较JOA评分改善率。[结果]3组患者术后随访JOA评分均有不同程度提高,但3组间无明显统计学差异;第1组术后早期椎间高度有丢失趋势(P<0.05),并有3例明显钛网下沉,2例内植物松动,第2组无松动或下沉病例,第3组有1例钛网下沉。[结论]3种方法均可得到可靠的临床效果,但在术后稳定性及椎间高度维持方面第2、3组较第1组满意。

[ Objective] To assess the clinical effect and radiologieal results of three methods of anterior cervical decompression and reconstruction for the treatment of multilevel cervical myelopathy. [ Method ] Fifty-two patients with continuous multilevel cervical myelopathy treated by the same team were divided into three groups. Group Ⅰ was performed the two-segmentcorpectomy and reconstructed with a long titanium mesh and plate. Group Ⅱ was performed the three-level-discectomy and fused with three cages. Group Ⅲ was performed the combination with corpectomy and discectomy. The parameters included intervertebral height, JOA score. The data was compared statistically with Student＇ s T-test or ANOVA. [ Result ] JOA score in all groups was improved post operation, but there was no significant difference among the three groups. The post-operation intervertebral height lose of group Ⅰ was more significant than other two groups, three cases of titanium meshs subsidence happened in group Ⅰ and one same case happened in group Ⅲ. [ Conclusion] All the three surgical methods of anterior decompression and fusion can procure wonderful clinical effect, but group Ⅱ and Ⅲ were better than group Ⅰ in the stability and the maintenance of intervertebral height post operation.