严重脊髓型颈椎病手术减压的安全术式探讨

The safety comparison of the different surgical strategies for severe cervical spondylotic myelopathy

目的:探讨严重脊髓型颈椎病手术减压的安全术式。方法:回顾性分析采用手术治疗的32例前方压迫较严重(致压物的矢状径大于椎管矢状径的50%)的脊髓型颈椎病患者的临床资料,其中21例行颈前路手术(A组),11例行后前路联合手术(B组),24例(A组15例,B组9例)得到1年以上的随访,对两组患者JOA评分改善率、手术时间、手术出血量,出现皮层体感诱发电位(CSEP)预警的情况进行比较。结果:术中A组CSEP预警13次,B组预警2次,多发生在骨赘切除、脊髓减压期间;两组JOA评分改善率在术后3d时(B组为71.02%,A组为67.12%)无显著性差异(P>0.05),术后1年时B组(81.76%)明显优于A组(72.04%)(P<0.05),而手术出血、手术时间B组(300±123ml;185±24min)明显多于A组(90±43ml;67±19min)(P<0.05)。结论:对严重脊髓型颈椎病患者行后前路联合手术减压较单纯前路手术增大了创伤、延长了手术时间、后路固定也加重了患者的经济负担,但手术安全性明显提高,有较好的神经功能改善率,是此类患者的首选术式。

Objective：To compare the safety of the different surgical strategies for the decompression of the severe cervical spondylotic myelopathy（CSM ）.Method：32 cases of CSM with magnitude osteophyte compressing the spinal cord anteriorly（cord compression ratio≥50%） who underwent surgical treatment in our department were reviewed.According to the surgical strategies,all the patients could be divided into 2 groups which were group A（anterior approach,21 cases） and group B（anterior and posterior combined approach,ll cases）.Out of the 32 cases,there were 24 cases （group A=15 cases;group B=9 cases） were followed-up more than 1 year. The JOA average improvement ratio,surgical time,blood loss and the early warning of CSEP were compared between the 2 groups.Result：There were 13 times early warning of CSEP in group A compared to 2 times in group B.There was no significant difference in the JOA average improvement ratio between group A （67.12%） and group B（71.02%） in 3 days post-operatively（P〉0.05）,but the JOA average improvement ratio was noticed much better in group B（81.76%） than in group A（72.04%） in 12 months （P〈0.05 ）.There were signifi- cant difference （the volume of hemorrhage in operation and operative time） between group A （90±43ml;67± 19min） and group B（300±123ml;185±24min）（P〈0.05）.Conclusion：In spite of the fairly bigger injure,longer operative time and more money needed,the combined approach surgery has very promising safety and better improvement of the nerves function,so the combined approach surgery is the best choice for severe cervical spondylotic myelopathy.