三种不同手术方法治疗脊髓型颈椎病的对比研究

A comparative study on three different surgical methods in treatment of cervical spondylosis

目的对比研究脊髓型颈椎病三种不同手术方法的临床疗效。方法自2011年9月至2013年9月共收治85例脊髓型颈椎病患者,分为A、B、C三组,接受三种不同的手术方法。A组采取颈前路颈椎间盘切除,椎间融合器(Gage)植骨融合,椎体锁定钛板内固定术。B组采用颈前路椎体次全切除,钛笼植骨融合,椎体锁定钛板内固定术。C组采用颈后路单开门椎管扩大成形,侧块钛板内固定术。结果 85例患者全部获得随访,随访时间1年到6年,手术疗效满意,其中疗效达到优45例,良31例,可7例,差2例,优良率为89.55%。A、B、C组优良率分别为90.00%、88.68%和91.67%。三组间术后神经功能改善优良率无明显差异(P>0.05)。结论三种手术方法治疗脊髓型颈椎病各自有其手术适应证,不能相互取代,在今后的临床工作中应严格掌握适应证,尽早实施手术可取得满意的治疗效果。

Objective To compare the effect of three different surgical methods in treatment of patients with cervical spondylosis. Methods A total of 85 patients with cervical spondylosis treated by 3 different kinds of cervical operation during the period of September 2011 to September 2013 were divided into A,B and C groups. Patients in group A were treated by resection of cervical intervertebral disc,anterior portion intervertebral fusion（ Gage） bone graft fusion and vertebral body locking titanium plate fixation. Patients in group B were treated by front road vertebral body subtotal resection,anterior portion titanium cage bone graft fusion and fixation with vertebral body locking titanium plate. Patients in group C were treated by expand forming,cervical posterior single door vertebra canal side piece of titanium plate fixation. Results All 85 patients received follow- up for 1 to 6 years. Excellent result had been got in 45 cases,good in 31 cases,common in 7 cases and bad in 2 cases. The rate of satisfactory effect rate was 89. 55%. Group A,B,C the excellent rates was respectively 90. 00%,88. 68% and 91. 67%. The difference in satisfactory effect rate and amelioration of nerve function among 3 groups was not statistically significant（ P〈0. 05）. Conclusion All these three surgical methods have their own surgical indications,and they cannot replace each other. It is important to choose good indications before operation and operation should be taken as soon as possible,then it will achieve good operation effect.