经前后路手术治疗脊髓型颈椎病疗效分析

Comparison of Effectiveness of Cervical Spondylotic Myelopathy Treated by Anterior and Posterior Operative Approaches

目的：分别总结经前、后路减压融合固定术治疗脊髓型颈椎病的体会,分析比较其治疗效果。方法：回顾性分析近年来我院骨科采取经前路减压钛网植骨融合内固定术治疗的28例、经后路减压融合侧块螺钉固定术治疗的19例脊髓型颈椎病病例,所有病例病变均在两个节段以上,术前术后按JOA评分标准评估患者的神经功能,比较术前、后之得分判定手术效果,进而比较分析两种术式的优长与不足。结果：术后随访6-26个月,平均12.9个月,经前路组平均改容善率78.9%,优良率89.3%,有效率96.4%,经后路组平均改善率80.2%,优良率89.5%,有效率94.7%,两组病例疗效无显著差异（P〉0.05）。结论：两种术式均为治疗脊髓型颈椎病的理想手段,对于压迫主要来自前方的脊髓型颈椎病,前路减压融合固定术确为理想的治疗手段,前路手术椎间融合率高,且融合方向与颈椎生物应力一致,安全性优,而后路手术对3个节段以上的减压以及解除后方压迫为主的病例较为适合。

Objective： To summarize the understanding of anterior and posterior operative approaches in the treatment of cervical spondylotic myelopathy separately, analyze and compare the effectiveness and treatments. Method： We reviewed 28 cases of titanium net bone graft pedestal to fuse internal fixation of anterior approach ,and 19 cases of bone graft plus lateral mass bolt internal fixation of posterior approach of the spinal cord decompression treated by our orthopaedics. Then evaluated the function according to JOA standard before and after the operation. Result： The follow - up period was 6 - 26 months and the average time was 12. 9 months. Average symptom improvement rate, fineness rate and effectiveness rate in anterior group and posterior approach group was 78.9% ,89.3% ,96.4% and 80.2% ,89.5% ,94.7% respectively,There＇s no significal difference （ P 〉 0.05 ）. Conclusion： Both of the approaches are ideal means for treating cervical spondylotic myelopathy. Anterior approaches are more safer for cervical spondylotic myeopathy for the compression than from the front side. Posterior approaches are more suitable for decompression which has more than 3 segments.