多节段脊髓型颈椎病不同手术方法早期临床疗效探讨

EARLY OUTCOME OF DIFFERENT OPERATION METHODS IN TREATMENT OF MULTI-SEGMENTAL CERVICAL SPONDYLOTIC MYELOPATHY

目的 比较3种不同手术方式治疗多节段脊髓型颈椎病（cervical spondylotic myelopathy,CSM）的早期临床疗效。方法 回顾性分析2011年1月-2013年3月收治的符合选择标准的74例多节段（≥3个间隙）CSM患者临床资料,根据手术方式不同分为3组,A组为钢板固定法单开门椎管成形术组（21例）,B组为锚定法单开门椎管成形术组（28例）,C组为传统单开门椎管成形术组（25例）。3组患者性别、年龄、病程、病变节段、术前日本骨科协会（JOA）评分及颈椎曲度（C2-7夹角）等一般情况比较差异无统计学意义（P〉0.05）,具有可比性。记录手术时间、术中出血量,术后6个月JOA评分、颈椎曲度及轴性症状发生率。结果 3组患者手术时间及术中出血量比较差异均无统计学意义（P〉0.05）。术后切口均Ⅰ期愈合。B、C组各1例患者于术后当天出现脑脊液漏,A组2例、B组1例、C组1例于术后出现C5神经根麻痹症状,经对症治疗后症状均消失。74例均获随访,随访时间12-39个月,平均18.3个月。A、B组患者锚钉及钢板位置良好,无松动脱出;C组2例术后出现＂再关门＂现象,重新手术固定后无＂再关门＂现象发生。术后6个月3组患者JOA评分均较术前显著增加（P〈0.05）;除A组颈椎曲度与术前比较差异无统计学意义（P〉0.05）外,B、C组颈椎曲度均较术前显著提高（P〈0.05）。术后6个月3组间比较JOA评分及颈椎曲度差异均有统计学意义（P〈0.05）。术后6个月A、B、C组轴性症状发生率分别为4.76%（1/21）、35.71%（10/28）和72.00%（18/25）,A组明显低于B、C组,B组低于C组,差异均有统计学意义（P〈0.017）。结论 钢板固定法单开门椎管成形术治疗多节段CSM早期临床疗效优于锚定法单开门椎管成形术及传统单开门椎管成形术。

Objective To explore the early outcome of 3 different operation methods in the treatment of multi-segmental cervical spondylotic myelopathy （CSM）. Methods A retrospective analysis was made on the clinical data of 74 patients with multi-segmental CSM treated between January 2011 and March 2013. The patients were divided into 3 groups according to operation methods： open-door expansive laminoplasty by plate was used in 21 patients （group A）, open-door expansive laminoplasty by anchor fixation in 28 patients （group B）, and conventional unilaterally open-door expansive laminoplasty in 25 patients （group C）. There was no significant difference in gender, age, disease druation, affected segments, preoperative Japanese Orthopaedic Association （JOA） score, and cervical curvature of C2-7 among 3 groups （P 〉 0.05）. The peration time, intraoperative blood loss, and JOA score, cervical curvature, incidence of axial symptoms were recorded. Results There was no significant difference of operation time and intraoperative blood loss between group A and group B （P 〉 0.05）. All incisions healed by first intention. Cerebrospinal leak occurred in 2 cases （1 case of group B and 1 case of group C） and Cs nerve root palsy in 4 cases （2 cases of group A, 1 case of group B, and 1 case of group C）; all the symptoms disappeared after symptomatic treatment. The patients were followed up 12-39 months （mean, 18.3 months）. The position of internal fixation was good without loosening and pulling out in groups A and B. Reclosed open-door was observed in 2 cases of group C, which disappeared after the second surgery. The JOA scores were significantly increased at 6 months after operation when compared with preoperative scores in groups A, B, and C （P 〈 0.05）. The cervical curvature of C2-7 at postoperation was significantly improved when compared with preoperative one in groups B and C （P 〈 0.05） except group A （P 〉 0.05） . There were significant differences in JOA score and the cervical curvature among 3 groups at 6 months after operation （P 〈 0.05）. The incidence of axial symptoms were 4.76% （1/21）, 35.71%（10/28）, and 72.00% （18/25） in groups A, B, and C respectively, showing significant differences （P 〈 0.017）. Condusion Open-door expansive laminoplasty by plate open-door expansive laminoplasty by anchor fixation and conventional unilaterally open-door treatment of multi-segmental CSM.