一期后前路联合手术治疗老年人脊髓型颈椎病

One-stage combined posteroanterior approach for surgical treatment of cervical spondylotic myelopathy in elderly patients

目的评估一期后前路联合手术治疗老年人脊髓型颈椎病的安全性及疗效。方法回顾性分析2007年1月-2010年1月接受一期后前路联合手术治疗脊髓型颈椎病的34例老年患者(男24例,女10例,年龄60～76岁)的临床资料,以同期收治的54例中青年患者(男43例,女11例,年龄29～59岁)作为对照,对两组患者的术前病程、术前合并症、前路减压节段数、出血量、术后引流量、术后并发症和平均住院日进行比较,按日本矫形协会(JOA)评分对两组患者术前、出院时及末次随访时的神经功能进行评价与比较。结果老年患者的术前合并症、出血量、术后引流量及并发症发生率均明显高于中青年患者(P<0.05),术前病程、减压节段数、平均住院日、手术前后及末次随访时的JOA评分两组比较差异无统计学意义(P>0.05)。结论通过正确的围术期处理、积极防治并发症,一期后前路联合手术治疗老年人脊髓型颈椎病安全有效。

Objective To evaluate the safety and efficacy of one-stage combined posteroanterior approach for surgical treatment of cervical spondylotic myelopathy in elderly patients.Methods A total of 34 elderly patients（24 males and 10 females,aged 60 to 76） who underwent one-stage combined posteroanterior approach for surgical treatment of cervical spondylotic myelopathy between Jan.2007 and Jan.2010 were involved in this retrospective study.Fifty-four young patients admitted during the same period（43 males and 11 females,aged 29 to 59） were enrolled as control.The differences in terms of preoperative course,preoperative complications,the number of vertebrae involved in anterior decompression,blood loss volume,postoperative drainage volume and complications,and mean length of hospital stay between the two groups were compared.Japanese Orthopaedic Association（JOA） score was employed to assess and compare neurological functions between two groups before surgery,at the time of discharge from hospital and the final follow-up.Results The number of preoperative complications,blood loss volume,and postoperative drainage volume and complications were greater in the elderly than in the young patients（P0.05）.There was no difference in course before operation,the number of vertebrae involved in decompression,mean length of hospital stay,and JOA scores before and after the surgery and at final follow-up between two groups（P0.05）.Conclusion One-stage combined posteroanterior surgery for cervical spondylotic myelopathy in elderly patients was safe and effective after proper perioperative management and prevention and treatment of complications.