多节段脊髓型颈椎病的前后路术式疗效分析

Effect of Anterior and Posterior Operative Approaches for the Treatment of Multilevel Cervical Spondylotic Myelopathy

【目的】分析和比较前后路术式治疗多节段脊髓型颈椎病的临床效果。【方法】对48例多节段脊髓型颈椎病患者分别采用颈前路2个（或2个以上）椎体次全切除脊髓减压、钛网植骨支撑融合内固定术（A组27例）及颈后路脊髓受压段全椎板切除减压、植骨加侧块螺钉内固定术（B组21例）治疗，术后根据JOA评分及X线表现比较两组病例的改善率、植骨融合率及颈椎生理曲度恢复情况。【结果】平均随访2年3个月，对两组术前、术后JOA评分进行统计处理，差异具有统计学意义（P〈0．05）；A组平均改善率70．20％，优良率为81．48％，B组平均改善率65．15％，优良率80．95％，两组疗效差异无显著性意义（P〉0．05），A组1例植骨未融合，植骨融合率96．30％，B组3例植骨未融合，植骨融合率85．71％，两组颈椎生理曲度均有不同程度恢复。【结论】两种术式疗效相近，但前路多个椎体次全切除脊髓减压、钛网植骨支撑融合内固定术植骨融合率高、术时短，较之后路术式更安全有效；合理选择适应证及手术方法可提高脊髓型颈椎病的临床改善率，减少并发症的发生。

[Objective]To analyze and compare the clinical effect of anterior and posterior operative approaches in the treatment of multi-segment cervical spondylotic myelopathy. [Methods] Among 48 cases of multisegment cervical spondylotic myelopathy, 27 cases（group A） were subjected to two and/or over two vertebral body subtotal resection for spinal decompression, titanium-net fusion and internal fixation of anterior approach, and the remaining 21 cases （group B） were subjected to total laminectomy for decompression, bone graft and lateral screw internal fixation of posterior approach. The improvement rate of symptom,bone graft fusion rate and recovery of cervical vertebra physiological curve were compared according to JOA standard and X-ray appearance after surgery. [Results] The average follow-up period was 2.3 years. Average symptom improvement rate and fineness rate in group A and group B were 70.20% and 81. 48% , 65.15% and 80.95%, respectively, with no significant difference（P〉 0.05）. Meanwhile,the bone graft fusion rate was 96.30% and 85.71%, respectively. Cervical vertebra physiological curve in two groups was restored to some extent. [Conclusion] Both procedures have similar therapeutic effect. Through anterior approach,bone graft fusion rate is higher, and the operating time is shorter, and the operation is safer. Choosing the indications and operation methods reasonably can raise the improvement rate of cervical spondylotic myelopathy and reduce the incidence of complications.