颈前路ROI-C与后路单开门治疗多节段脊髓型颈椎病的对比

Anterior cervical decompression and fusion with ROI-C cage versus posterior open door laminoplasty for multilevel cervical spondylotic myelopathy

[目的]比较颈椎前路减压椎间桥形融合器(ROI-C)内固定术和后路单开门术治疗多节段脊髓型颈椎病的临床疗效。[方法]分析2013～2016年在本院手术治疗的50例多节段脊髓型颈椎病患者。其中,22例行前路减压椎间桥形融合器内固定(前路组),28例行后路单开门术(后路组)。比较两组围手术期结果、临床疗效、影像学结果和并发症。[结果]两组手术时间差异无统计学意义(P>0.05);前路组术中出血量、术后住院时间小于后路组(P<0.05)。平均随访(16.96±5.35)个月,末次随访时,两组JOA评分、VAS评分较术前均显著改善(P<0.05),两组同时间点JOA评分和VAS评分差异无统计学意义(P>0.05)。两组末次随访颈椎曲度(Cobb角)较术前均无明显改变(P>0.05),组间相同时间点Cobb角差异无统计学意义(P>0.05);两组末次随访ROM较术前均明显减少(P<0.05),前路组ROM显著小于后路组(P<0.05)。在并发症方面:前路组1例吞咽困难,2例假体位置不正,1例邻近节段退变;后路组1例C5神精麻痹,1例颈痛加重,1例邻近节段退变。并发症发生率差异无统计学意义(18.18%vs. 10.71%, P>0.05)。[结论]对多节段脊髓型颈椎病,颈椎前路减压椎间桥形融合器内固定具有术中出血量少、术后住院时间短的优点,但更易发生术后颈椎活动度减少。

[Objective] To compare the clinical outcomes of anterior cervical decompression and fusion(ACDF) with ROIC cage versus posterior open door laminoplasty for multilevel cervical spondylotic myelopathy(MCSM). [Methods] From 2013 to 2016, 50 patients with MCSM were surgically treated in our hospital. Of them, 22 patients underwent ACDF with ROI-C cage(the anterior group), and 28 patients received posterior open door laminoplasty(the posterior group). The operative time, blood loss and hospital stay, as well as JOA, VAS, cervical alignment(Cobb angle), and cervical range of motion(ROM) were compared between them. Complications were recorded during follow-up. [Results] The operative time in the anterior group was similar to the posterior group(179.77±67.16 min versus 209.50±67.85 min, P>0.05), and the blood loss was significantly less in the anterior group than the posterior group(150.00±40.83 ml versus 357.14±87.89 ml, P<0.05), in addition, the hospital stay after surgery was significantly shorter in anterior group than posterior group(7.77±1.66 days versus 9.86±3.09 days, P<0.05). The patients were followed up for an average of(16.96±5.35) months. At the latest follow-up, the JOA score and VAS improved significantly in comparison to those preoperatively in both groups(P<0.05), but no significant difference was found between the two groups either preoperatively or at the final follow-up(P>0.05). There was no significant change in the Cobb angle at the final follow-up in both groups(P>0.05), and no significant difference of Cobb angle was noted between the two groups either preoperatively or at the latest follow-up(P>0.05). The ROM was significantly decreased in both groups at the latest follow up compared to those preoperatively(P<0.05). The anterior group had significantly less ROM than the posterior group at the latest follow up(P<0.05), despite no significant difference between them preoperatively(P>0.05). In term of complications, the anterior group had dysphagia after surgery in 1, malposition of cage in 2, and adjacent segmental deterioration in 1 patient, whereas the posterior group had axial pain in 1, C5 palsy in 1, and adjacent segmental deterioration in 1 patient. There was no significant difference in the incidence of complications between the two groups(18.18% vs. 10.71%, P<0.05). [Conclusion] For multilevel cervical spondylotic myelopathy, the ACDF with ROI-C cage take advantage of less blood loss and shorter hospital stay, while disadvantage of more loss of cervical range of motion than the posterior laminoplasty.