多节段颈脊髓病前、后路手术方法的选择

Methods for multilevel cervical spondylosis

目的探讨多节段颈脊髓病前、后路手术治疗方法的选择。方法随访85例多节段颈脊髓病患者,其中采用前路分节段减压植骨融合内固定术治疗60例,后路椎板切除减压内固定术治疗25例,评估患者神经功能改善、颈椎生理曲度的恢复情况及术后并发症。结果所有患者术后JOA评分均有改善;各手术组患者颈椎Cobb角术后与术前比均有显著差异(P<0.05);前路与后路Cobb角差值比较有显著性差异(P<0.01)。术后均无神经症状加重现象,术后各并发症经处理后均缓解。结论对于多节段颈脊髓病,前后路手术都是直接有效的治疗方法,其中分节段减压植骨融合术是前路治疗多节段颈脊髓病的首选手术方法。合理地选择病例,制订科学地手术方案,并行彻底减压,是获得满意疗效的关键。

Objective To study the choice of surgical methods for multilevel cervical spendylosis. Methods Eighty-five cases of multilevel cervical spondylosis were treated surgically,including 60 cases by anterior approach,25 cases by posterior approach. The improvement of neurological function,the restoration and reconstruction of the lordosis and postoperative complications were observed. Results Neurological function of all the cases was improved according to JOA score. There were significant differences between preoperative and immediately postoperative in Cobb angle of all the groups （P0.05）,and there were significant differences between anterior approach and posterior approach in Cobb angle （P0.01）. There was no increase of neurological symptoms postoperation. Postoperative complications were to ease after the treatment. Conclusion Both anterior approach and posterior approach are predominantly effective in the treatment of multilevel cervical spondylosis. Segmental anterior cervical decompression and fusion is the first anterior approach choice for treating multilevel cervical spondylosis. A reasonable choice of cases,formulation a scientific operation program according to the characteristics of different cases and complete decompression are the keys to a satisfactory effect.