前路分段减压手术治疗多节段脊髓型颈椎病的疗效分析

Analysis of clinical effects of anterior segmental decompression for multi-segment cervical spondylotic myelopathy

目的:探讨前路分段减压手术治疗多节段脊髓型颈椎病的疗效。方法 :对2005年8月至2016年3月收治的多节段脊髓型颈椎病84例患者的临床资料进行回顾性分析,根据手术方式分为对照组和观察组,每组42例。对照组男26例,女16例,年龄(56.87±11.89)岁,病程(7.91±3.71)年,病变节段C3-C636例,C4-C76例。观察组男24例,女18例,年龄(54.58±12.56)岁,病程(8.03±3.52)年,病变节段C3-C634例,C4-C78例。对照组行后路椎管扩大成形术治疗,观察组行前路分段减压法治疗。观察两组患者的手术时间、术中出血量、住院时间、植骨融合时间及并发症发生率;比较两组患者术前和术后3、6、12个月的JOA评分和融合节段Cobb角。结果:观察组的手术时间、术中出血量、住院时间及并发症发生率明显低于对照组(P<0.05);观察组的植骨融合时间也明显低于对照组(P<0.01);术后3、6、9个月,观察组的JOA评分和融合节段Cobb角均明显高于对照组(P<0.01)。结论:前路分段减压法治疗多节段脊髓型颈椎病具有椎体切除少、减压彻底、术后稳定性好、并发症少等优点,可有效促进脊髓功能及椎体稳定性恢复。

Objective：To evaluate the clinical effects of anterior segmental decompression for the treatment of multi segment cervical spondylotic myelopathy. Methods：The clinical data of 84 patients with multi segment cervical spondylotic myelopathy treated between August 2005 to March 2016 were retrospectively analyzed. According to different operative methods the patients were divided into control group and observation group,with 42 cases in each group. In the control group,including 26 males and 16 females,the age was（56.87±11.89） years old and course of disease was（7.91±3.71） years on average,the lesion segment occurred on C_3-C_6 of 36 cases and on C_4-C_7 of 6 cases. There were 24 males and 18 females in observation group,with the mean age of（54.58±12.56） years old,and the course of disease was（8.03±3.52） years,the lesion segment occurred on C_3-C_6 of 34 cases,and on C_4-C_7 of 8 cases. The patients in control group were treated with posterior laminoplasty,and the patients in observation group underwent anterior segmental decompression. Operation time,intraoperative blood loss,hospitalization time,bone graft fusion time and complication rate were observed between two groups. JOA scores and Cobb angle of fusion segment were compared before operation and 3,6,9 months after operation. Results：Operation time,intraoperative blood loss,hospitalization time and complication rate in observation group were significantly lower than in control group（P〈0.05）;the bone fusion time in observation group was significantly lower than in control group（P〈0.01）;3,6,9 months after surgery,JOA score and the segment Cobb angle in observation group were significantly higher than in control group（P〈0.01）.Conclusion：Anterior segmental decompression for the treatment of multi segment cervical spondylotic myelopathy has obvious advantages of less vertebral resection,thorough decompression,good stability,less postoperative complications,which can effectively promote the recovery of the spinal cord function and vertebral stability.