多节段脊髓型颈椎病的外科治疗

Surgical treatment for multi-segmental cervical spondylotic myelopathy

目的 探讨多节段脊髓型颈椎病的外科治疗入路及方法。方法 自2009-01-2013-01行连续性多节段脊髓型颈椎病手术治疗63例患者,其中36例行前路分节段脊髓减压,27例行后路改良锚定单开门椎板扩大成形术。结果 所有患者得到随访平均24个月（12-36个月）。前路组平均手术时间明显长于后路组,前路组术中失血量多于后路组（P〈0.05）,而住院天数后路组长于前路组,前路组术后后凸畸形矫正方面明显好于后路组,在末次随访VAS评分2组比较差异无统计学意义（P〉0.05）。在术后末次随访时VAS评分、JOA评分、Odom评分、NDI评分等2组无明显区别,在轴性症状、C5神经根麻痹方面后路组多于前路组。结论 前路组及后路组在治疗多节段脊髓型颈椎病均可以取得满意的临床疗效,前路组在手术时间、出血量多于后路组,前路组恢复颈椎的序列,并发症少于后路组,但必须根据患者具体情况选择手术方式。

Objective To explore the surgical approach and method of multi-segmental cervical spondylotic myelopathy. Methods Sixty three cases diagnosed as multi-segmental cervical spondylotic myelopathy from January 2009 to January 2013 were selected. Among them, 36 patients were treated by segmental anterior cervical decompression with fusion on multi/evel cervical myelopathy （anterior group）, while the others by anchoring nails in the expansive laminoplasty （posterior group）. Results All patients were followed up for 24 months （range from 12 to 36 month）. The difference in operative time and blood loss between the two groups was significant （P 〈0.05）. The hospitalization time in posterior group was longer than anterior group. The result of VAS score, JOA score, NDI and Odom score in two groups also showed no significant difference at final follow-up （P 〉0.05）. There were no complications of spinal cord injury, cerebruspinal fluid leakage and infection. In anterior group the segmental lordosis, axial symptoms and Cs palsy were less than posterior group. Conclusion The surgical approach and method should be selected according to the specific condition of patient. With the development of surgical technique and instrument, the clinical effects of both are satisfactory.In anterior group the segmental lordosis, axial symptoms and C5 palsy are less than posterior group.