脊髓型颈椎病的术式选择及术后神经功能恢复效果比较

Surgical selection of cervical spondylotic myelopathy and comparision of recovery effect of postoperative neurological function

目的探讨不同手术方式在脊髓型颈椎病治疗中的应用，分析患者神经功能恢复情况。方法对130例脊髓型脊椎病患者进行研究，随机分为研究组和对照组，每组65例。研究组行前路椎问盘切除植骨融合并钛板置入内固定（ACDF）术，对照组行前路椎体次全切除植骨融合并钛板置入内固定（ACCF）术，比较两组术后神经功能恢复情况、生活质量、出血量、住院及手术时间、并发症发生率。结果研究组术后5个月神经功能评分为（13．12±2．05）分，高于对照组的（11．01±2．14）分，差异有统计学意义（P〈0．05）；研究组各项生活质量评分高于对照组，差异有统计学意义（P〈0．05）；研究组出血量、住院与手术时间均少于对照组，差异有统计学意义（P〈0．05）；研究组并发症发生率为4．62％，低于对照组（16．92％），差异有统计学意义（P〈0．05）。结论ACDF与ACCF两种术式均可改善脊髓型颈椎病患者病情，其中ACDF能降低术后并发症率，进一步改善患者颈部神经功能，疗效更确切，值得临床推广。

Objective To investigate the application of different surgical methods in the treatmerit of cervical spondylotic myelopathy and analyze the recovery of neurological function. Methods One hundred and thirty patients with cervical spondylotic myelopathy were selected and ran- domly divided into the study group （n = 65 ） and the control group （n = 65 ）. The study group was given anterior cervical discectomy and fusion （ACDF）, and the control group was given anterior cervical corpectomy and fusion （ACCF）. The recovery of postoperative neurological function, quality of life, amount of blood loss, hospital stay, operative time and complications rate were compared between the two groups. Results The neurological function score at 5 months after operation was （ 13.12± 2.05） points in the study group, which was significantly higher than that in the control group with （11.01 ± 2. 14） points （P 〈 0. 05 ）. The quality of life score in the study group was higher than that in the control group （ P 〈 0.05 ）. The amount of blood loss, hospital stay and operative time in the study group were smaller than those in the control group （P 〈0.05）. The complications rate was 4. 62% in the study group and 16. 92% in the control group, and the former one was lower than the latter one （P 〈 0.05）. Conclusions ACDF and ACCF can improve the condition of patients with cervical spondylotic myelopathy, and ACDF can reduce the postoperative complications rate, and further improve the neurological function of patient＇s neck, and it has more exact efficacy, therefore it is worthy of clinical promotion.