减压椎间植骨融合内固定术与单纯减压术治疗颈椎多节段退变的对比分析

Comparative analysis of the anterior decompression and fusion with internal fixation and simple decompression in the treatment of cervical vertebral multilevel degeneration

目的分析减压椎间植骨融合内固定术与单纯减压术治疗颈椎多节段退变的临床价值。方法选取2012年至2014年我院收治的颈椎多节段退变患者40例,随机将患者分为2组,20例患者行减压椎间植骨融合内固定术(内固定组),20例单纯减压术(减压组),所有患者完整随访,对比分析2组患者的临床治疗效果。结果术后患者VAS评分和JOA评分显示,内固定组相较于减压组患者评分明显改善,差异具统计学意义(P<0.05)。与单纯减压术相比,减压椎间植骨融合内固定术术后颈椎曲度以及手术节段曲度改善明显,尤以术后1年最为明显,差异具有统计学意义(P<0.05)。术后1年颈椎关节活动度均较术前有所改善,差异具有统计学意义(P<0.05);末次随访2组患者颈椎关节活动度较治疗前差异无统计学意义(P>0.05);内固定组相较于减压组治疗颈椎多节段退行性病变术后颈椎活动度改善效果显著,差异具有统计学意义(P<0.05)。结论减压椎间植骨融合内固定术治疗颈椎多节段退变临床效果优于单纯减压术,可以满足临床生物力学方面的要求。

Objective To analyze the clinical value of anterior decompression and fusion with internal fixation and simple decompression in the treatment of cervical vertebral multilevel degeneration. Methods Selected 40 patients with cervical degenerative changes in our hospital from 2012 to 2014, and 20 patients of them underwent anterior decompression and fusion with internal fixation while the other 20 ca- ses took simple decompression. All the patients were well followed up, and the clinical therapeutic effect of the two groups were compared and analyzed. Results After operation, the VAS score and JOA score showed that the scores of the patients underwent anterior decompression and fusion with internal fixation were significantly improved compared with the simple decompression group, and the difference was statistically significant（ P 〈 0.05 ）. Compared with the simple decompression group, the cervical curvature and the curvature of the surgerysection in the anterior decompression and fusion with internal fixation group were significantly improved, especially in the first year after surgery （P 〈 O. 05 ）. The cervical spine joint activity of the two group were improved in the first year after surgery, and the difference was significant （ P 〈 0.05 ）, but there was no significant difference in the degree of cervical joint activity at the last follow-up （ P 〉 0.05 ）. The anterior de- compression and fusion with internal fixation is better than simple decompression in the degree of cervical joint activity with statistical signifi- cance （P 〈 0.05 ）. Conclusion The clinical effect of anterior decompression and fusion with internal fixation in treatment of multiple segment degeneration of cervical spine is better than that of simple decompression,it can meet the clinical requirements of biomechanics.