两种颈前路减压重建术治疗多节段脊髓型颈椎病的疗效分析

Two surgical modalities of anterior cervical decompression and reconstruction in treatment of cervical spinal cord spondylosis

目的探讨两种颈前路减压重建术治疗多节段脊髓型颈椎病的临床疗效。方法对49例多节段脊髓型颈椎病患者分别采用颈前路多椎间隙减压、椎间融合器（Caga）植骨融合术（28例）及颈前路多椎间隙减压、植骨块椎问植骨钛板内固定术（21例）治疗，并进行疗效分析（包括术后神经功能改善情况、椎间隙高度及颈椎曲度的变化、植骨融合情况等）。结果两组患者术后神经功能评分较术前均有明显改善，两组之间的差异无统计学意义（P〉0．05）；两组患者术后侣个月椎间隙高度与术后3d比较。均无明显丢失．两组之间的差异也无统计学意义（P〉0．05）；但Cage组患者颈椎曲度值大于钛板组，差异有统计学意义（P〈0.05）。结论两种手术方法治疗多节段脊髓型颈椎病，患者术后植骨融合率均较高，神经功能恢复均较好，并均能保持椎间隙高度，但Cage较钛板能更好维持颈椎生理曲度。

Objective To evaluate two surgical modalities of anterior cervical decompression and reconstruction in treat- ment of multilevel cervical spondylotic myetopathy. Methods Forty nine patients with multilevel cervical spondylotic myelopathy were treated with anterior cervical decompression and reconstruction, including 21 cases with interbody fusion cage （cage group） and 28 cases fixed with titanium plate （titanium plate group）. The nerve function, height of intervertebrat space, cervical curvature and spinal fusion after treatment were axamined and compared between two groups. Results The neurological scores of patients were significantly improved compared to that before surgery, there was no significant difference between two groups （P 〉0.05）. There was no significant loss in height of intervertebral space at 18 months compared d3 after surgery two groups（P 〉0.05）, and also no difference between two groups. However, the cervical curvature in cage group was better than that in titanium plate group （P〈0.05）. Conclusion Both surgical modalities are effective for multi-segmental cervical spondylotic myelopathy, but the use of cervical fusion cage is better in maintaining cervical curvature.