严重脊髓型颈椎病手术方式探讨及临床观察

Clinical study and investigation of the types of surgical for severe cervical spondyiotic myelopathy

目的探讨严重脊髓型颈椎病手术方式，对临床疗效进行观察。方法回顾性分析2002年12月-2007年6月收治的20例前方压迫较重的脊髓型颈椎病患者的临床资料，男15例，女5例；年龄33岁～72岁，平均51．5岁。其中A组10例行颈前路手术，4例行颈后路手术；B组6例I期行后前路联合手术。依据JOA17分评分法评估术前和末次随访时的神经功能状况，比较术后1周和1年随访时JOA评分改善率。结果术后并发脑脊液漏1例，节断性神经根麻痹1例。随访3～24个月，平均11．5个月，JOA评分：术前平均为7．35±1．23分，术后末次随访时平均为14．45±0．78分。JOA评分改善率在术后一周时无显著性差异（A组中颈前路68．13％，颈后路66．35％，B组72．04％，P〉0.05），术后1年时B组（81．68％）明显优于A组（颈前路72．12％，颈后路70．79％）（P〈0.05）。结论对严重脊髓型颈椎病患者，行后前路联合手术较单纯前路手术或单纯后路手术创伤大、手术时间长、手术效果好，有较好的神经功能改善率，临床上应视患者前方压迫程度及是否合并有颈椎OPLL症或颈椎管狭窄症等情况而选择相应的手术方式，可取得良好的手术效果。

Objective To investigate the different surgical strategies for the severe cervical spondylotic myelopathy（CSM） by studing the clinical effect.Methods From December 2002 to June 2007, 20 cases of CSM with magnitude osteophyte compressing the spinal cord anteriorly are reviewed.Among the 20 patients,15 males and 5 females,their ages averaged 51.5 years（ranged,33-72 years）.All the patients could be divided into 2 groups which were group A （anterior approach, 10 cases and posterior approach, 4 cases） and group B （one-staged posterior and anterior combined approach, 6 cases）. JOA 17 score scale was used for the neurological assessment of pre-opcration and final follow up. the JOA improvement rate after a week and 12 months were compared.Result There were 1 patient with dural tear and 1 with segmental nerve root palsy.All cases were regularly followed up.The duration of follow up averaged 11.5months（ranged,3-24months）.The pre-opcration JOA score was 7.35±1.23,the JOA score of final follow up was 14.45±78. There was no significant difference in the JOA average improvement rate between group A（anterior approach,68.13% and posterior approach, 66.35%） and group B （72.04%） in 7 days post-operation （P〉0.05）,but the JOA improvement rate was noticed much better in group B （81.68%） than in group A （anterior approach,72.12% and posterior approach, 70.79%） in 1 year post-operation （P〈0.05）. Conclusion In spite of the fairly bigger injury,longer operative time,the combined approach surgergy has better operative effect and improvement of the nerves function comparing with only anterior approach or posterior approach. More over considering the patient＇s situation of the decompression of the severe CSM, whether combining with OPLL and cervical spinal stenosis or not ,a much better surgery is choosed finally indeed,satisfied effect could be obtained.