多节段脊髓型颈椎病前路与后路治疗效果比较

Comparison of Clinical Effect between Anterior and Posterior Approaches in Treatment of Multilevel Cervical Spondylotic Myelopathy

目的比较多节段脊髓型颈椎病(multilevel cervical spondylotic myelopathy,MCSM)前路治疗与后路治疗临床效果。方法选取石河子大学医学院第一附属医院于2012年10月—2013年11月收治的MCSM 35例,根据手术方法分为观察组21例和对照组14例。观察组采用颈前路椎体次全切除内固定术或颈前路分节段减压内固定术,对照组采用颈后路椎管成形术。观察2组手术时间、术中出血量、手术前后日本外科协会(JOA)评分、脊髓功能改善情况、颈椎生理曲度变化以及手术并发症发生情况。结果观察组手术时间长于对照组,术中出血量多于对照组(P<0.01)。2组术后脊髓功能改善情况及并发症发生率比较差异无统计学意义(P>0.05)。观察组末次随访时颈椎生理曲度较术前和对照组增大,对照组较术前减小(P<0.05,P<0.01)。2组末次随访时JOA评分较术前提高(P<0.01)。结论前路或后路治疗MCSM均能有效改善脊髓功能状态,且并发症较少,临床疗效佳,临床应根据患者具体情况选择术式。

Objective To compare clinical effect between anterior and posterior approaches in treatment of multilevel cervical spondylotic myelopathy （MCSM）. Methods A total of 35 patients with MCSM admitted during October 2012 and November 2013 were divided into observation group （ n = 21 ） and control group （n = 14） according to operative method. Observation group was treated with＇ anterior cervical corpectomy fixation （ACCF） or anterior segmental decom- pression and internal fixation （ACHDF） trdaiment, while control group was treated with posterior cervical open - door laminoplasty （LP） treatment. Operative time, intraoperative bleeding volume, Japanese orthopaedic association （JOA） scores before and after operation, functional recovery of spinal cord, cervical physiological curvature changes before and after operation and incidence rate of complication were observed in two groups. Results In observation group, values of operative time and intraoperative bleeding volume were significantly higher than those in control group （ P 〈 0.01 ）. There were no significant differences in functional recovery of spinal cord and incidence rate of complication between two groups （P 〉 0.05）. Degree of cervical physiological curvature at the end of follow-up in observation group was increased compared with those before treatment and in control group, and the degree after treatment was significantly decreased compared with that before treatment in control group （P 〈 0. 05, P 〈 0. 01 ）. In two groups, JOA scores at the end of follow- up were significantly increased compared with those before treatment （P 〈 0. 01 ）. Conclusion Anterior or posterior ap- proaches in treatment of multilevel cervical spondylotic myelopathy can effectively improve functional recovery of spinal cord with less postoperative complications and well clinical effect.