四个节段以上伴椎间不稳颈椎病手术治疗的分析

Analysis of the Surgical Treatment of Four or More Levels Cervical Spondylopathy with Intervertebral Instability

目的:分析四个节段以上同时伴有椎间不稳的多节段颈椎病的手术入路及手术方法。方法:回顾性分析2008年10月-2012年12月收治的符合入选标准的颈椎病患者64例,其中A组33例,采用传统颈前路分节段开窗减压植骨内固定术;B组31例,采用改良颈后路单开门椎管减压轴侧植骨Arch钛板内固定术。采用日本矫形外科学会(JOA)评分标准和疼痛视觉模拟(VAS)评分标准对患者术后疗效进行评价,并对两组患者的术中出血量、手术时间、住院日数、颈椎活动度、颈椎曲度进行比较。结果:所有患者手术均顺利,A组患者的手术时间为(150.7±30.3)min,B组为(90.8±22.2)min,较A组明显缩短,差异具有统计学意义(P<0.05)。A组患者的术中失血量为(320±50)m L,B组为(180±45)m L,较A组明显减少,差异具有统计学意义(P<0.05)。此外,B组患者的住院时间显著短于短于A组(P<0.05)。两组患者术后切口均I期愈合,出院时JOA评分及VAS评分均较术前明显改善(P<0.05)。出院后6个月时,A组患者的Ishihara指数较术前显著改善(2.2±1.6),而B组无明显改善,A、B两组比较差异具有统计学意义(P<0.05);A组患者的活动度丢失(4.2±3.3)°,B组活动度丢失(4.0±2.9)°,两组比较差异无统计学意义(t=0.26,P>0.05)。结论:颈前路及颈后路手术方式治疗四个节段以上伴有椎间不稳颈椎病的患者均可获得理想的临床疗效,但颈后路手术方式的手术时间短,术中出血量少,住院周期短,安全性高,适应症广,是治疗四个节段以上颈椎病伴椎间不稳首选的手术方式。

Objective： To analyze the surgical approach and method for patients with 4 or more levels cervical spondylopathy with intervertebral instability. Methods： 64 eligible patients admitted from Nov 2008 to Dec 2012 were enrolled for the retrospective analysis.33 cases were chosen as the traditional anterior cervical discectomy and fusion with plate fixation surgery（group A）, another 31 patients were chosen as improved single door verterbral canal pressure-reducing shaft grafts Arch titanium plate fiation surgery（group B）. After treatment, the clinical outcomes were assessed using Japanese Orthopedic Association（JOA） score andvisual analogue scale（VAS） score.The length of operation time, blood loss, hospital stays, range of motion of cervical spine, cervical spine curvature were also compared.Results： All the patients were operated successfully. The mean operation time of group B（90.8±22.2 min） was significantly shorter than that of group A（150.7±30.3 min）,（P〈0.05）. The average amount of blood loss was less in group B（180±45 m L） than that of group A（320±50 m L, P〈0.05）. The hospitalization day of group B was significantly shorter than that of group A（P〈0.05）. The surgery incision of two groups were all healed at stage I. The JOA and VAS score were both significantly improved when discharging discharge from hospital compared with the preoperative scores of 2 groups（P〈0.05）. At 6 months after the surgery, there were significant differences of Ishihara Index between group A（improved 2.2±1.6） and group B（no difference improve）（P〈0.05）. There was no significant difference in the Cobb angle between Group A（ reduced 4.2±3.3°） and group B（reduced 4.0±2.9°）（P〈0.05）. Conclusions： Both the anterior and posterior cervical discectomy could obtain ideal clinical efficacy. However, the posterior way showed shortened operation time, reduced blood loss, shortened hospitalization length, improved security and broaden the operation indications, and could be a better surgery manner for the patients wirh 4 or more levels cervical spondylopathy with intervertebral instability.