颈椎前路Hybrid微创手术在多节段颈椎病治疗中的疗效观察

Anterior cervical approach for Hybrid minimally invasive surgery in treatment of multilevel cervical myelopathy

目的探讨颈椎前路Hybrid微创手术在多节段颈椎病治疗中的临床效果。方法选择2010年1月至2016年12月在内蒙古医科大学附属医院和北京大学第三医院治疗的多节段颈椎病患者46例,根据手术方案分为对照组(23例)和观察组(23例)。对照组采用传统前路长节段椎体次全切除减压术治疗,观察组采用颈椎前路Hybrid微创手术治疗,采用颈椎功能障碍指数(NDI)及日本骨科协会评估治疗分数(JOA)对治疗效果进行评估;采用直观模拟量表(VAS)对2组围术期疼痛进行评估,比较2组临床疗效及对疼痛的影响。结果观察组手术后NDI评分低于对照组,差异具有统计学意义(P <0. 05);观察组手术后JOA评分高于对照组,差异具有统计学意义(P <0. 05);观察组术后1 d、3 d及5 d VAS疼痛评分均低于对照组,差异具有统计学意义(P <0. 05);观察组术后并发症发生率为8. 70%,低于对照组的13. 04%,差异具有统计学意义(P <0. 05)。结论颈椎前路Hybrid微创手术用于多节段颈椎病效果理想,有助于改善患者颈椎功能,缓解患者疼痛。

Objective To investigate the clinical effects of Hybrid minimally invasive surgery through anterior cervical approach on patients with multi-level cervical spondylosis. Methods A total of 46 multi-segment cervical spondylosis patients who volunteered to affiliated hospital of Inner mongolia university and third hospital of Peking university from January 2010 to December 2016 were selected and divided into control group（n = 23） and observation group（n = 23） according to the surgical plan. The control group was treated with long segment cervical corpectomy and fusion. The observation group was treated with anterior cervical Hybrid minimally invasive surgery. The treatment effect was evaluated by cervical disability index（NDI） and Japanese Orthopaedic Association（JOA）; the perioperative pain was assessed by visual analog scale（VAS）,and the clinical efficacy and the effect of pain between two groups were compared. Results The NDI score of the observation group was lower than that in the control group,the difference was significant（P 〈 0. 05）. The JOA score of the observation group after the operation was higher than that of the control group,the difference was significant（P 〈 0. 05）. The VAS of the observation group on days 1,3,and 5 after surgery were lower than those of the control group,the difference was significant（P 〈 0. 05）; the postoperative complication rate in the observation group was 8. 70%,which was lower than 13. 04% of the control group,the difference was significant（P 〈 0. 05）. Conclusion Hybrid minimally invasive surgery for cervical anterior cervical spine is effective in patients with multi-level cervical spondylosis. It is helpful to improve cervical spine function and relieve pain in patients.