两种前路减压融合术治疗颈椎病的疗效对比

Intermediate Outcome of Cervical Discectomy and Fusion for Single-level Cervical Myelopathy:A Comparative Study of Cloward Method and Modified Smith-Robinson Method

目的 比较Cloward法与改良Smith—Robinson法（Smith—Robinson法＋钛板内固定）治疗单节段颈椎病的疗效。方法 37例颈椎病患者分别采用Cloward法（15例）与Smith-Robinson＋钛板内固定（22例）。采用SAS6．12软件对两组术式术前、术后1周、最后随访时JOA评分、融合节段及全颈椎Cobb角、融合节段椎体前高及后高进行统计学分析。结果 随访6～48个月，平均22个月。两种术式最后随访JOA评分无显著性差异，Cloward法术后融合节段椎体高度、颈椎生理前凸无变化；改良Smith-Robinson法术后融合节段椎间高度、颈椎生理前凸部分恢复，并可以维持。结论 近期观察证明两种手术方法都可以改善神经功能，但改良Smith-Robinson法可改善并维持融合节段椎问高度及颈椎生理前凸。

Objective To compare the intermediate outcomes between Cloward Technique and modified Smith- Robinson technique （standard Smith-Robinson technique accompanying with anterior cervical plate） on single-level cervical myelopathy patients. Methods From June 1997 to June 2004, 37 cases with cervical myelopathy secondary to single-level degenerative disc herniation received anterior decompression and inter-segment bony fusion. Among whom, 15 in Group A received Cloward decompression and 22 in Group B received modified Smith-Robinson decompression. Average follow-up was 22 months （6 to 48 months）. Neurologic result（JOA） and radiologic results（Af, A2～7, Ha and Hp） were examined to compare their outcome. SAS6. 12 Software was introduced to do statistical analysis. Results At the final follow-up time, JOA scores improved in both groups with no statistical difference existed between them, kyphotic deformity in group A did not correct, while that in group B corrected and maintained significantly as confirmed by Af, A2～7 Ha and Hp results. Conclusion Intermediate follow-up showed both Cloward technique and modified Smith-Robinson technique could improve neurological function significantly of single level cervical myelopathy, while the latter could further correct cervical kyphotic deformity and maintain cervical lordosis.