颈椎病前后路Ⅰ期联合手术与分期手术疗效比较

Efficacy of one-staged vs two-staged of anterior-posterior approach vs simple anterior or posterior approach surgery for cervical spondylosis

目的：通过研究颈椎病前后路Ⅰ期联合手术与分期手术临床效果,评价Ⅰ期前后路联合手术的意义.方法：回顾2001年6月至2008年12月本院收治的26例颈脊髓前后方同时受压患者,根据患者意愿和耐受能力,接受Ⅰ期前后路联合手术或分次手术或单次手术,JOA评分标准评价术后疗效.结果：8例行Ⅰ期前后路联合手术减压内固定,JOA评分：术前7.9±2.1,术后15.3±2.1;10例分期行颈椎后路、前路手术,JOA评分：术前8.2±2.3,第2次手术术后最近1次随访评分：15.5±1.6;8例行单纯颈椎后路或前路手术,术后患者症状和阳性体征基本消失,JOA评分：术前7.8±2.0,术后15.0±1.3.3种不同方式治疗的患者术前和术后JOA评分差异无统计学意义（P〉0.05）.结论：对各种原因引起颈脊髓前后方同时受压的患者,Ⅰ期前后路联合手术,可使忠者彻底解除颈髓受压迫,有利于脊髓功能恢复.但Ⅰ期前后路联合手术可能增加手术风险.

Objective：To investigate the efficacy of one-staged vs two-staged anterior-posterior approach vs simple anterior or posterior approach surgery for cervical spondylosis, and to evaluate the value of one-staged anterior-posterior approach. Methods： Between May 2001 and December 2008,26 patients with anterior and posterior compression of the cervical spinal cord were recruited, and received surgery using one-staged or twostaged anterior-posterior approach, or simple anterior or posterior approach, depending on their tolerance and willingness to surgical options. The postoperative efficacy was evaluated by JOA scores. Results：Eight patients were treated by one-staged anterior-posterior approach surgery （JOA scores： preoperative 7. 9 ± 2. 1 vs postoperative 15.3 ± 2.1 ） and 10 by two-staged anterior-posterior approach surgery （JOA scores： preoperative 8.2 ±2.3 vs 15.5 ± 1.6 immediately after the second session）. Eight patients received simple posterior or anterior approach which resulted in resolution of symptoms and positive signs （ JOA scores ： preoperative 7.8 ± 2. 0 vs postoperative 15.0 ± 1.3 ）. No significant difference was found in the preoperative or postoperative JOA scores among patients treated by three different methods （ P 〉 0.05 ）. Conclusion： For patients with coexisting anterior and posterior compression caused by various reasons, one-staged anterior-posterior approach surgery can lead to the complete decompression that appears promising in recovery of spinal function, but should be balanced on the increased risk of surgery.