颈后路内固定手术方式的选择与术后疗效的相关性分析

Correlation analysis between choice of different posterior operative ways of fixation and postoperative clinical effect

目的通过比较颈后路椎弓根钉（CPS）及侧块螺钉（LMS）内固定术后疗效，探讨两种术式选择的临床意义。方法2009—02—2012-02，回顾性分析63例多节段脊髓型颈椎病（M—CSM）患者。A组M—CSM患者共31例，行后路减压CPS固定。其中，男23例，女8例；年龄42—70岁，平均57．0岁。B组M—CSM患者共32例，行后路减压LMS固定。其中，男21例，女11例；年龄45—68岁，平均56．8岁。患者常规行颈椎CT、MRI、X线（正侧、过伸过屈位）检查，分析比较患者术前、术后、随访时临床症状、颈椎曲度（CI）、轴性症状（AS）评分。结果随访时间24—48个月，平均36个月。临床症状采用JOA评分比较，A组康复率（62．1±25．2）％，B组（61．6±24．8）％，经分析无统计学意义（P〉0．05）。A组CI变化率为（1．6±1．1）％，B组（3．6±2．1）％，经比较其变化差异有统计学意义（P〈0．05）。A组发现明显AS比例12．9％，B组31．2％，差异有统计学意义（P〈0．05）。A组未发现内固定并发症；B组患者2年随访时发现3例侧块螺钉松动现象，占比9．4％。结论颈后路手术采用椎弓根钉内固定对维持颈椎稳定性作用更为显著，亦减少明显AS发生率。提示临床制定颈后路手术方案应充分结合下颈椎解剖结构，周全考虑安全性、操作性、手术习惯等因素，选择恰当的颈后路固定方式。

Objective To compare the clinical effect of cervical pedicle screw and lateral mass screw fixation, and explore the clinical significance of choosing two different ways of operation. Methods From January 2009 to January 2012, the clinical data of 63 patients with multilevel cervical spondylotic myelopathy were reviewed in this study. Among them, 31 patients underwent cervical pedicle screw in group A,which consisted of 23 males and 8 females. The mean age was 57.0 years old （ranged 42-70）. 32 patients received lateral mass screw fixation in group B,which consisted of 21 males and 11 females. The mean age was 56.8 years old（ranged 45-68）. All patients underwent X-ray examination, the recovery rate was calculated using pre- and postoperative JOA scores for each patient. Postoperative cervical CI and AS were compared between two groups. Results All patients were followed up for 24-48 months （average 36 months）. The average JOA recovery rate was 62.1%±25.2% in group A, and that was 61.6%±24.8% in group B. There was no significant difference in clinical recovery rate. Loss of cervical curvature index was 1.6%±1.1% in group A, and that was 3.6%±2.1%% in group B. The difference was significant in loss of cervical Curvature indices between two groups. The rate of evident axial symptoms was 12.9% in group A, and that was 31.2% in group B, the difference was statistically significant （P〈0.05）. The rate of fixation failure in group B was 9.4%. Conclusion The effect of pedicle screw fixation on the stability of cervical spine was more significant, and the incidence of AS was decreased significantly. To choose appropriate posterior operative ways of cervical surgery should be fully combined with cervical anatomy, consideration of safety, operability, surgical habits and other factors.