单纯前入路与后入路治疗多节段脊髓型颈椎病的疗效对比研究

Comparison analysis of anterior and posterior pathways surgery for patients with multilevel cervical spondylotic myelopathy

目的比较单纯前入路与后入路治疗多节段脊髓型颈椎病(MCSM)的疗效及对患者生活质量的影响。方法收集2008年6月至2012年6月收治的140例MCSM患者作为研究对象。随机分为前路组70例和后路组70例。前路组给予单纯前入路手术治疗,后路组给予后入路手术治疗。比较两组患者手术状况、日本骨科协会评估(JOA)评分、视觉模拟评分(VAS),颈椎功能障碍指数(NDI)以及生活质量。结果两组患者术中出血量与症状消失时间差异无统计学意义(P>0.05),前路组手术时间显著短于后路组,其治疗后JOA评分显著高于后路组,差异具有统计学意义(P均<0.05)。经过治疗后,两组VAS评分及NDI较治疗前均显著降低,差异均具有统计学意义(P均<0.05);两组VAS评分比较差异无统计学意义(P>0.05),后路组NDI显著低于前路组,差异具有统计学意义(P<0.05)。两组患者治疗后生活质量均显著提高,后路组在活力、情绪角色与心理卫生方面的评分均显著高于前路组,差异均具有统计学意义(P<0.05)。结论单纯前路手术与后路手术治疗MCSM各有优势,临床上需要结合病人的实际情况做出选择以达到较好的临床获益。

Objective To compare the efficacy of anterior and posterior pathways surgery for patients with multilevel cervical spondylotic myelopathy（ MCSM） and provide clinical basis for clinical therapy. Methods From June 2008 to June 2012,140 MCSM cases were collected and divided into 2 groups randomly. 70 cases were in anterior pathways group（ APG） and 70 cases in posterior pathways group（ PPG）. The APG was treated with anterior pathways surgery and the PPG was treated with posterior pathways surgery. The surgery status,JOA score,VAS score,NDI and life quality of the 2 groups were observed and compared. Results The length of the surgery of the APG was significantly shorter than that of the PPG（ P〈0. 05）. The JOA score of the APG was significantly higher than that of the PPG after treatments（ P〈0. 05）. The VAS score of the 2 groups had no significant difference after treatments. The NDI of PPG was significantly lower than that of the APG after treatments. The activity,emotion role,and the physiological health score in the life quality of the PPG were all significantly higher than those of the APG after treatments（ P〈0. 05）. Conclusion Anterior and posterior pathways surgeries for patients with MCSM have their own advantages respectively and meets for different need in clinic.