多节段脊髓型颈椎病的前路或后路与后前路联合手术的临床疗效及并发症分析

Multi-segmental cervical spondylotic myelopathy with anterior or posterior joint surgery before and after the clinical efficacy and complications

目的观察多节段脊髓型颈椎病行单纯前路或后路与后前路联合手术后的脊髓功能改善及预后状况，探讨后前路联合手术的临床疗效及并发症情况。方法将2001年1月至2008年1月收治的298例多节段脊髓型颈椎病患者按手术方式分为三组：颈前路手术减压植骨钛网植入钛板内固定术121例（单纯前路手术组），后路单开门椎管扩大成形术112例（单纯后路手术组），后前路联合手术65例（后前路联合手术组）。行脊髓功能日本骨科学会（JOA）评分、体感诱发电位检查，对比三组患者的术后疗效。结果全部病例均获得1～7年随访，平均（4．7±1．4）年。单纯前路手术组改善率78．1％，优良率72．7％（88／121），单纯后路手术组改善率70．6％，优良率66．1％（74／112）。两组比较差异有统计学意义（P〈0．05）。后前路联合手术组改善率86．7％，优良率83．1％．（54／65），与单纯前路手术组、单纯后路手术组比较差异均有统计学意义（P〈0．05）。结论在治疗多节段脊髓型颈椎病的手术中，后前路联合手术在疗效上明显优于单纯前路手术或单纯后路手术。脊柱稳定性单纯前路手术、单纯后路手术、后前路联合手术逐一降低。

Objective To observe the multi-segmental cervical spondylotic myelopathy with simple anterior or posterior joint pre-and post-operative prognosis of spinal cord function improved and the status, explore co-operation after the clinical efficacy and complications. Methods The clinical data of 298 cases of multi-segmental cervical spondylotie myelopathy with anterior or posterior of the simple pre-and post-joint surgery from January 2001 to January 2008 were retrospectively analyzed. The clinical efficacy, titanium anterior cervical decompression and fusion surgery net implanted titanium plate fixation 121 cases, posterior open-door laminoplasty 112 cases, 65 cases of combined surgery before and after. JOA score line of spinal cord function and somatasensory evoked potential, as compared 3 groups after surgical efficacy. Results All patients were followed-up 1- 7 years, averaged （4.7± 1.4） years. The anterior cervical decompression and fusion surgery titanium mesh implanted titanium plate fixation to improve the rate was 78.1%, excellent and good rate was 72.7%（ 88/121 ）. Posterior open-door laminoplasty to improve the rate was 70.6%, excellent and good rate was 66.1% （74/112）, there was statistically significant between them （P 〈 0.05 ）. After anterior surgery, improving rate was 86.7%, excellent and good rate was 83.1% （54/65）. Anterior and posterior combined surgery before and after comparison was significant （P 〈 0.05）, regardless of near-term results, long-term effects were better than that of anterior or posterior surgery. Conclusions The spinal cord in the treatment of multi-segmental operation of cervical spondylosis after anterior surgery is obviously superior to the efficacy of anterior or posterior surgery alone. Spinal stability anterior, posterior, after a joint operation before the lower one by one.