多节段脊髓型颈椎病的颈椎前后路减压内固定治疗的对比研究

Comparative study on the effect of anterior and posterior decompression in the treatment of multi-segmental cervical spondylotic myelopathy

目的:对比分析颈前路与颈后路两种方式治疗多节段脊髓型颈椎病的临床疗效,为临床治疗提供一定指导。方法:回顾性分析我院收治的72例多节段脊髓型颈椎病患者,按手术方式分为行颈前路椎间盘切除减压融合术(ACDF)或椎体次全切除植骨融合术(ACCF)的前路组37例,行颈后路椎管成形术(LP)的后路组35例,比较两组患者的一般资料,手术资料及术后功能恢复情况。结果:两组性别、年龄、病程、术前JOA评分、随访时间、受累节段比较,差异均无统计学意义(P>0.05)。前路组手术时间长于后路组,术中出血量少于后路组,差异均有显著性(P<0.05)。两组术后脊髓功能均较术前有明显改善,且前路组功能改善更明显(P<0.05)。前路组术后颈椎生理曲度明显增加,而后路组术后生理曲度明显下降(P<0.05)。两组术后并发症发生率比较无显著差异(P>0.05)。结论:颈前路与颈后路手术治疗MCSM患者术后脊髓功能均明显改善,前路手术可有效恢复颈椎生理曲度。建议对MCSM患者应综合考虑其临床特征及不同手术方法的特点,合理选择适合的术式,可获得更好的疗效及减少并发症的发生。

Objective： To analyze and compare the clinical efficacy of anterior and posterior decompression in the treatment of multi-segmental cervical spondy[otic myelopathy （MCSM）, providing certain guidance for the ctinicat treatment. Methods ： A total of 72 patients with MCSM who were admitted in our hospital were included in the study and divided into the anterior group （n= 37） and the posterior group （n= 35） according to different surgical methods. The patients in the anterior group were given anterior cervical discectomy fusion （ACDF） and anterior cervical corpectomy fusion （ACCF）, while the patients in the posterior group were given laminoplasty （LP）. The general materials, surgical materials, and postoperative functional recovery in the two groups were compared. Results： The comparison of gender, age, course, preoperative JOA score, follow-up time, and affected segment between the two groups was not significant different（P〉0.05）. The operation time in the anterior group was significantly longer than that in the posterior group, but the intraoperative amount of bleeding was significantly lessthan that in the posterior group （P〈0.05）. The postoperative spinal cord function in the two groups was significantly improved when compared with before operation （P〈0.05） ; moreover, the improved degree in the anterior group was more obvious. The postoperative cervical physiological curvature in the anterior group was significantly increased, but in the posterior group it was significantly reduced （P〈0. 05）. The comparison of the occurrence rate of postoperative complieations between the two groups was not statistically significant （P〉0.05）. Oonclusions： The anterior and posterior surgeries in the treatment of MCSM can significantly improve the postoperative spinal cord function, among which the anterior surgery can effectively recover the cervical physiological curvature. It is recommended that an appropriate surgical method should be reasonably selected by comprehensively considering the clinical characteristics of MCSM patients and the characteristics of different surgical methods in order to obtain better curative effect and reduced complications.