多节段脊髓型颈椎病前后路手术治疗的疗效比较

Comparation of therapeutic effects between anterior and posterior surgery in multilevel cervical spondylotic myelopathy

目的比较前路减压植骨内固定和后路单开门椎管扩大成形术对多节段脊髓型颈椎病的治疗效果。方法回顾性分析2003-01～2009-01手术治疗多节段脊髓型颈椎病患者68例,前路减压植骨内固定33例(A组),后路全椎板切除减压术或单开门椎管扩大成形术治疗35例(B组),术前和术后按照JOA评分系统进行评分并计算恢复率,MRI测量硬脊膜囊矢状径并计算膨胀回复率。结果术后随访6个月～4年2个月,平均1年11个月,两组手术病例术前JOA评分及硬脊膜矢状径比较差异无统计学意义(P>0.05),术后JOA评分和恢复率,硬脊膜囊矢状径和膨胀回复率前路手术组高于后路手术组,差异均有统计学显著意义(P<0.05)。结论前、后路减压手术均是治疗多节段脊髓型颈椎病的有效方法,前路减压植骨内固定术优于后路全椎板切除减压或单开门椎管扩大成形术。

Objective To compare retrospectively the therapeutic effeets between anterior and posterior surgery in multilevel eervical spondylotic myelopathy（CSM） with 3 or more segments. Methods In sixty-eight patients with multilevel CSM from Jan 2003 to Jan 2009,33 patients were operated from anterior approach, with selectively decompression and bone grating with plate fixed （group A） ;35 cases were operated from posterior approach, with decompressive lamineetomy posteriorly or mon-open-door vertebral canal expansing laminoplasty （group B）. All patients were scored with JOA evaluating system and measured the sagittal diameter of dural sac, calculated the recovery rate as well. Results The follow-up period were 6 months to 4 years and 2 months, average was 1 year and 11 months. There were no statistical difference in JOA scores and sagittal diameter of dural sac between group A and B before operation（ P 〉 0. 05 ） ; while after operation, there were significant difference between the two groups （ P 〈 0. 05 ）, the JOA scores and recovery rate of group A was higher than those of group B. Conclusion Anterior and posterior approach were effective operations for multilevel CSM, however, the anterior approach were surpass than posterior approach in the therapeutic effects.