不同手术方法治疗多节段脊髓型颈椎病临床效果分析

Clinical analysis of different surgical methods in treatment of multi-segmental cervical spondylosis myelopathy

目的比较颈椎前路椎体次全切除及椎间隙减压植骨融合内固定术与颈椎后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病的临床效果。方法回顾性分析我院2014年8月?2016年8月收治的75例多节段脊髓型颈椎病患者的临床资料,并按照不同入路手术方式分为两组,其中颈前路手术组40例,颈后路手术组35例。比较两组患者术中出血量、手术时间,术前及术后的脊髓神经功能及其改善率、颈椎生理曲度。结果与颈后路手术组相比,颈前路手术组术中出血量及手术时间显著减少(P<0.05)。两组患者组内术后6个月及术后1年的JOA评分均显著高于术前(P<0.05);且颈前路手术组术后1年脊髓功能改善优良率显著高于颈后路手术组(P<0.05)。颈后路手术组的术后颈椎生理曲度较术前显著降低(P<0.05),而颈前路手术组的术后颈椎生理曲度较术前显著增高(P<0.05),且颈前路手术组显著高于颈后路手术组(P<0.05)。结论颈前入路治疗多节段脊髓型颈椎病的术中出血量明显小于经颈后入路,可有效缩短手术时间,使患者的脊髓神经功能得到明显改善,脊椎生理曲度得到更好地恢复,故其临床治疗效果更佳。

Objective To compare the clinical effects of anterior cervical subtotal corpectomy and intervertebral space decompression and bone graft fusion internal fixation and posterior cervical single open-door laminoplasty in the treatment of multi-segmental cervical spondylotic myelopathy(MCSM).Methods The clinical data of 75 patients with MCSM of our hospital from Aug 2014 to Aug 2016 were analysed retrospectively.All the patients were divided into two groups according to the different surgical techniques.The anterior cervical surgery group were 40 cases,the posterior cervical surgery group were 35 cases.The intraoperative bleeding volume,operation time,improvement rate of the neurological function in spinal cord,cervical curvature before and after operation in the two groups were compared.Results Compared with the posterior cervical surgery group,the intraoperative bleeding volume and operation time in the anterior cervical surgery group were significantly less(P<0.05).The JOA score at 6 months,1 year after surgery of two groups was significantly higher than that before operation(P<0.05).Moreover,the excellent rate of spinal cord function improvement was significantly higher in anterior cervical surgery group than that in the posterior cervical surgery group at 1 year after operation(P<0.05).After operation,cervical curvature of the posterior cervical surgery group was significantly lower than that before operation(P<0.05).However,cervical curvature in the anterior cervical surgery group was significantly higher than that before operation(P<0.05).And the cervical curvature in the anterior cervical surgery group was significantly higher than that in the posterior cervical surgery group after operation(P<0.05).Conclusion Compared with posterior cervical surgery,the intraoperative bleeding loss of the cervical anterior surgery for MCSM is significantly less,it can effectively shorten the operation time,improve the function of spinal cord obviously,and make the cervical curvature better recovery,so the clinical therapeutic effect is better.