两种颈椎前路手术治疗多节段脊髓型颈椎病的临床疗效与安全性

Observation of the curative effect of the two kinds of anterior cervical operation in the treatment of multsegment cervical spondylosis myelopathy patients

目的比较两种不同的颈前路手术治疗多节段脊髓型颈椎病的临床疗效和安全性,为临床治疗选择手术方式提供参考。方法选取2013年3月~2015年6月我院行颈前路手术治疗的多节段脊髓型颈椎病患者98例,手术方法包括前路长节段椎体次全切除减压、钛笼内植骨、钛板内固定术(LTTS)和椎体次全切除、椎间盘切除减压联合钛笼、cage植骨融合术(SITC)。采用LTTS的患者共50例为A组;采用SITC的患者共48例为B组。治疗结束后一年内每隔3个月复诊一次。观察指标包括手术用时、术中出血,术后伤口感染、喉上神经或喉返神经损伤,内固定松动的发生率,植骨融合率、颈椎高度与曲度变化以及神经功能分改善率等。结果 B组手术时间明显少于A组(P<0.05);B组术中出血量明显少于A组(P<0.05);两组患者术后均未见感染发生和喉上神经或喉返神经损伤相关的临床表现;A组内固定松动的发生率显著高于B组(P<0.05);两组患者的植骨融合率差异均无统计学意义(P>0.05);两组患者术前和术后椎体高度均无统计学差异(P>0.05),但相较于自身治疗前均有显著改善(P<0.05);两组患者术前和术后颈椎曲度均无统计学差异(P>0.05),但相较于自身治疗前均有显著改善(P<0.05);两组患者的神经功能改善率差异无统计学意义(P>0.05)。结论两种术式均具有较好的临床疗效,但从安全性和操作性来看,SITC更具有优势。

Objective To observe the clinical efficacy and safety of the two kinds of anterior cervical operation in the treat- ment of multi segment cervical spondylosis myelopathy patients and provide reference for the selection of operative methods in clinical treatment. Methods 98 multi segment cervical spondylosis myelopathy patients treated by operation in our hospital from March 2013 to June 2015 were retrospectively analyzed. The operation methods included LTTS and SITC. 50 patients were di- vided into A group treated by the LTTS. 48 patients were divided into B group treated by the SITC. The observed indicators in- cluded the operative time, the amount of bleeding in the operation, infection, superior laryngeal nerve and recurrent laryngeal nerve injury, the incidence of internal fixation loosening, the bone graft fusion rate, the change of vertebral height and vertebral curvature and the neurological function improvement rate. Results The operative time and amount of bleeding of B group were significantly less than that of A group （P〈0. 05）. There were no infections occurred and the clinical manifestation of the injury of the superior laryngeal nerve or the recurrent laryngeal nerve occurred in the two groups. The incidence of loosening of internal fixation of A group and B group were 26.00% and 6. 25% （P〈0. 05）. The bone graft fusion rate of A group and B group were 78.00% and 83.33% （P〈0.05）. Preoperative and postoperative vertebral height of A group were （32.11 ± 1.51） mm and （36.18±1.72） mm. Preoperative and postoperative vertebral height of B group were （32.27±1.44） mm, （36.98±1.63） ram. There were no significant differences between the two groups before and after the operation. The vertebral height after operation were significantly improved compared with that before operation （P〈0.05）. Preoperative and postoperative vertebral curvature of A group were（4. 41 ±2.29）mm and （6.29 ±1.87）mm. Preoperative and postoperative vertebral curvature of B group were（4.37±2.18）mm and（6.18± 1.92）mm. There were no significant differences between the two groups before and af- ter the operation. The postoperative vertebral curvature were significantly improved compared with the preoperative vertebral curvature （P〈0. 05）. The neurological function improvement rate of A group and B group were （86.4 ± 9.2）% and （85.7 ± 10.6） % （P〉0. 05）. Conclusion（s） Two kinds of operation methods can obtain satisfactory curative effect. SITC has more ad- vantages for security and operability.