重症脊髓型颈椎病手术治疗33例临床分析

A retrospective study of surgical treatment of severe cervical spondylotic myelopathy

目的通过观察重症脊髓型颈椎病行单纯前路手术与前后路联合手术两种不同手术方式的疗效，探讨重症脊髓型颈椎病的最佳手术方式。方法回顾性研究自2002年6月～2007年6月33例重症脊髓型颈椎病病例。对患者进行术前JOA评分，并行颈椎正侧位片及MRI检查，术后一周行JOA评分，术后一年行随访行JOA评分，并行颈椎正侧位片及MRI检查。根据影像学资料计算颈椎前凸角、邻近节段椎间盘退变指数，比较手术前、术后相关指标的变化，评价临床治疗效果。结果与术前相比，2组术后JOA评分均有明显改善，与术前相比差异有统计学意义（P〈0．05）；术后颈椎生理曲度均有不同程度变小，相应颈椎前凸角变小，与术前相比差异有统计学意义（P〈0．05）。颈椎前凸角及邻近节段的退变指数与术前相比，差异有统计学意义（P〈0．05）；而组间比较，差异无统计学意义（P〉0．05）。结论单纯前路手术和前后路联合手术术后均存在一定程度的邻近节段退变；二者均能有效缓解重症脊髓型颈椎病的临床症状；对于合并存在黄韧带钙化导致后方受压或椎管发育性狭窄的病例，选取前后路联合手术，预后较好。

Objective To observe the curative effect of anterior surgery and posterior-anterior surgery in severe cervical spondylotic my- elopathy cases for exploring which method is better. Methods 33 severe cervical spondylotic myelopathy cases were studied. Each patient took X-ray and MRI, and was graded by the JOA system before and after surgery. The cervical ante-salient angle and degeneration index of the adjacent disc were calculated and studied. Results Both two groups had a significant development in JOA score after surgery （ P 〈 0. 05 ）. The difference of improvement rate between two groups was not significant in one week after surgery （ P 〉 O. 05 ） , while improvement rate of the anterior-posterior group was much higher than that in the anterior group in one year after surgery （ P 〈 0, 05 ）. The cervical antesalient angle became much more smaller in both two groups a year after surgery （ P 〈0. 05 ）, and so was the degeneration index of the adjacent disc （ P 〈 0. 05 ）. There was no significant difference of the degeneration index between two groups in a year after surgery （ P 〉 0.05 ）. Conclusions The adjacent segment degeneration happened in both two groups. Both two methods can improve the clinical symptom of severe spondylotic myelopathy patients. But when refer to the cases with pressiou caused by both posterior and anterior matters, the posterior-anterior surgery is better.