前、后路手术治疗多节段脊髓型颈椎病的疗效比较研究

Analysis about therapeutic effects of anterior or posterior approach in multilevel cervical spondylotic myelopathy, a comparison study

目的比较前路减压植骨内固定和后路单开门椎管扩大成形术对多节段脊髓型颈椎病的治疗效果。方法回顾性分析该院2001年1月～2004年6月手术治疗多节段脊髓型颈椎病患者78例,前路减压植骨内固定43例,后路全椎板切除减压术或单开门椎管扩大成形术治疗35例,术前和术后按照JOA评分系统进行评分并计算恢复率,MRI测量硬脊膜囊矢状径并计算膨胀回复率。结果术后随访6～50个月,平均23个月,两组手术病例术前JOA评分及硬脊膜矢状径比较无统计学意义(P>0.05),术后JOA评分和恢复率,硬脊膜囊矢状径和膨胀回复率前路手术组高于后路手术组,差异均有统计学意义(P<0.05)。结论前、后路减压手术均是治疗多节段脊髓型颈椎病的有效方法,前路减压植骨内固定术优于后路全椎板切除减压或单开门椎管扩大成形术。

[Objective] To compare the therapeutic effects of of anterior or posterior approach in multilevel cervical spondylotic myelopathy （CSM） with 3 or more segments. [Methods] A retrospective study, 78 cases of operated multilevel CSM , who were admitted in our hospital from Jan 2001 to Jun 2004. 43 patents were operated from anterior approach, selectively decompress and bone grating with plate fixed （group A）. 35 cases were operated from posterior approach, with decompressive laminectomy posteriorly or mon-open-door vertebral canal expansing laminoplasty （group B）. All patents were scored with JOA evaluating system and measured the sagittal diameter of dural sac, calculated the recovery rate as well. [Results] The follow-up period were 6 months to 4 years and 2 moinths, and the average was 1 year and 11 months. There were no statistical difference in JOA scores and sagittal diameter of dural sac in group A and B before operation （P 〉0.05）, while after operation, there was significant difference in the two groups （P 〈0.05）, group A was higher than group B. [Conclusion] Anterior and posterior approach were effective operations to therapia multilevel CSM, however, the therapeutic effects of anterior approach were surpass than posterior approach.