颈椎前路减压分段融合术和后路椎管扩大成形术治疗多节段脊髓型颈椎病的病例对照研究

Case-control study of anterior cervical decompression plus sublevel fusion and posterior cervical laminoplasty for the treatment of multilevel cervical spondylotic myelopathy

目的：比较颈椎前路减压分段融合术和后路椎管扩大成形术治疗多节段脊髓型颈椎病的临床疗效。方法：对2009年7月至2012年6月收治的56例多节段脊髓型颈椎病病例进行回顾性分析，男32例，女24例；年龄42-79岁，平均（56．9±12．8）岁，病程2个月-16年，平均（10．6±3．2）年。所有患者术前经影像学检查显示有多节段颈椎间盘突出，并具有脊髓型颈椎病的临床表现。其中34例采用颈椎前路减压分段融合术（前路组），22例采用后路椎管扩大成形术（后路组）。通过影像学资料对两组患者手术前后的病变节段前柱高度和颈椎前曲度进行比较，并采用JOA评分评价手术效果。结果：两组患者无神经血管并发症发生，并获得24—36个月的随访（平均28．6个月）。前路组，术后2周时颈椎病变节段前柱高度较术前明显增高（P〈0．05），颈椎前曲度较术前明显降低（P〈0．05）。后路组，术后2周及末次随访时，病变节段前柱高度和颈椎前曲度较术前差异均无统计学意义（P〉0．05）。两组间在术后2周及末次随访时颈椎前曲度差异有统计学意义（P〈0．05）。术后两组JOA评分均出现了明显恢复，术后3个月及末次随访时，前路组明显高于后路组（P〈0．05），且JOA评分改善率前路组也优于后路组（P〈0．05）。结论：这种分段式前路融合手术可以有效地恢复颈椎前柱高度，并且与颈椎后路椎管扩大成形术相比，可以显著地改善脊髓功能，是治疗多节段脊髓型颈椎病的有效方案。

Objective：To compare the clinical outcomes of anterior cervical decompression plus sublevel fusion and posterior cervical laminoplasty in treating multilevel cervical spondylotic myelopathy. Methods：The clinical data of 56 patients with multilevel cervical spondylotic myelopathy were retrospectively analyzed from July 2009 to June 2012. There were 32 males and 24 females,aged from 42 to 79 years old with an average of（56.9±12.8）years. All patients had the typical clinical features of cervical spondylotic myelopathy,radiological evidences,and courses of disease were from 2 months to 16 years with an average of（10.6 ±3.2）years. Of them,34 patients were treated with anterior cervical decompression plus sublevel fusion（anterior fusion group） and 22 patients with posterior cervical laminoplasty（posterior laminoplasty group）. JOA score and radiological data were used to evaluate the clinical results. Results：No complications about nerve and blood vessel was found and the patients were followed up from 24 to 36 months with an average of 28.6 months. In anterior fusion group,the cervical anterior column height was significantly increased and the anterior cervical curvature angle was significantly decreased at 2weeks after surgery（P〈0.05）. In posterior laminoplasty group,there was no significant difference in above items between preoperative and postoperative at 2 weeks,final follow-up. Postoperative at 2 weeks and final follow-up,there was significant difference in anterior cervical curvature angle between two groups（P〈0.05）. Postoperative JOA score had obviously improved in all patients,at 3 months after operation and final follow-up,anterior fusion group was better than that of posterior laminoplasty group（P〈0.05）. Conclusion：The anterior sublevel fusion can effectively restore cervical anterior column height,and compared with the posterior cervical laminoplasty,it can obviously improve the spinal cord function. It is an effective method for the multilevel cervical spondylotic myelopathy.