两种颈前路减压重建术治疗多节段脊髓型颈椎病的疗效比较

Two procedures of anterior cervical decompression and reconstruction in the treatment of multilevel cervical spondylotic myelopathy

目的 探讨两种颈椎前路减压重建术治疗多节段脊髓型颈椎病的临床疗效.方法 我院2009至2013年采用颈椎前路单节段间盘切除、椎间融合器植骨融合钛板内固定术（A组）及颈椎前路椎体次全切除、钛网椎间植骨钛板内固定术（B组）治疗的多节段脊髓型颈椎病患者210例,根据手术方式分为两组,进行疗效分析.结果 术后7d、术后3个月、术后6个月、术后18个月各时间点,A组患者神经功能改善[日本骨科协会（JOA）评分]分别为（12.94±3.82）、（13.95±3.19）、（4.12±3.95）、（14.06±3.85）分和B组（12.73±3.53）、（13.39±3.95）、（14.09±3.53）、（14.11±2.98）分,两组JOA评分均较术前明显改善,两组比较JOA评分的差异无统计学意义（P＞0.05）;两组患者术后椎间隙高度比较差异无统计学意义（P＞0.05）,A组颈椎生理曲度深度（弧弦距）分别为（9.11±2.34）、（9.36±1.88）、（9.89±2.46）、（9.61±1.62） mm和B组（7.57±0.78）、（7.76±0.91）、（7.21±0.33）、（7.36±0.79） mm,A组均大于B组,A组植骨融合率为96.3％,B组为89.0％,A组高于B组.结论 两组术后神经功能恢复较好,两组术后均能保持椎间隙高度;但椎间融合器植骨融合率较钛网椎间植骨融合率高,而且椎间融合器组与钛网组比较能较好的维持颈椎生理曲度.

Objective To investigate the clinical curative effect of two procedures of anterior cervical decompression and reconstruction in the treatment of multilevel cervical spondylotic myelopathy.Methods In our hospital from 2009 to 2013 the anterior cervical single segmental discectomy,interbody bone graft fusion and titanium plate internal fixation （group A）,and anterior cervical subtotal resection,titanium mesh cage bone and titanium plate internal fixation （group B） were used in 210 patients with multilevel cervical spondylotic cervical spondylosis.The efficacy was evaluated.Results On the 7th day,3rd month,6th month,and 18th month after the surgery,the scores of Japanese Orthopaedic Association （JOA） were significantly increased in group A （12.94 ± 3.82,13.95 ± 3.19,4.12 ± 3.95,14.06 ± 3.85） and group B （12.73 ± 3.53,13.39 ± 3.95,14.09 ± 3.53,14.11 ± 2.98）,but there was no significant difference between the two groups.There was also no significant difference in the disc height between the two groups after surgery.On the 7th day,3rd month,6 month,and 18 month after the surgery,the values of cervical curvature in group A were [（9.11 ±2.34）,（9.36 ±1.88）,（9.89 ±2.46）,（9.61 ±1.62） mm],and those in group B were [（7.57±0.78）,（7.76±0.91）,（7.21 ±0.33）,（7.36±0.79） mm] （P〈 0.05）.The bone fusion rate in group A was 96.3% and that was 89.0% in group B respectively （P 〈 0.05）.Conclusion The postoperative recovery of neurological function was satisfactory in both two groups.The two surgical procedures can maintain disc height.The bone fusion rate in group A was significantly higher than in group B.The cervical lordosis in group A was maintained better than in group B.