不同前路减压术治疗脊髓型颈椎病的疗效分析

The analysis of efficacy produced by different anterior decompressions for cervical spondylotic myelopathy

目的观察不同术式前路减压手术效果,为脊髓型颈椎病的前路手术治疗提供术式选择依据。方法回顾性分析2001年7月至2009年6月笔者施行多种前路减压融合内固定术治疗并有完整随访资料的106例脊髓型颈椎病病例,男73例,女33例;单间隙25例,双间隙71例,三间隙10例。术前术后按JOA评分标准及SF-36生活质量评分评估患者的手术疗效。结果本组病例根据压迫情况不同而采用不同前路术式均获得良好效果,前路直接减压彻底、效果好。术后随访7个月至9年,平均3.9年,1年平均改善率86.26%,有效率100%,优良率89.62%。结论对于压迫主要来自前方的脊髓型颈椎病,根据颈髓受压情况选择合适的前路减压术,可以直接切除脊髓前方致压物,减压效果明显。

Objective To observe the effect of different anterior decompressions, and to provide basis for the choice of anterior surgery procedures in the treatment of cervical spondylotic myelopathy （CSM）. Methods 106 cases （73 males, 33 females） with CSM were analyzed retrospectively, and all of them were treated with various anterior cervical decompressions, fusions and internal fixations from July 2001 to June 2009. All the 106 patients had complete follow-up data. The lesions were located in 1 intervertebral space （n=25）, in 2 intervertebral spaces （n=71）, and in 3 intervertebral spaces （n= 10）. Preoperatively and postoperatively, the rating criteria of the Japanese Orthopaedic Association （JOA） and the Short Form （SF-36） Health Survey Questionnaire were used to evaluate the efficacy of the surgery. Results According to different compression conditions of all cases, we chose different anterior operation procedures and achieved satisfactory results, which showed that direct anterior decompressions were thorough and effective. The average follow-up period was 3.9 years （range, 7 months - 9 years）. In 1-year follow-up, the average symptom relief rate was 86.26%, efficacy rate was 100%, and excellent and good rate was 89.62%. Conclusions For cervical spondylotic myelopathy with compression coming from the front side, proper anterior decompression based on the specific conditions is able to directly eliminate the compression. It has obvious effect of decompression.