髂骨块与Cage椎间植骨融合治疗脊髓型颈椎病的疗效比较

Comparison of the Efficacy of Autologous Iliac Bone Grafting with Cage Intervertebral Grafting in the Treatment of Cervical Spondylotic Myelopathy

目的对比不同植骨融合方式的颈椎前路手术治疗脊髓型颈椎病的临床疗效。方法收集于2010年3月—2014年3月因脊髓型颈椎病就诊于滨州医学院附属医院脊柱外科的患者60例,按植骨融合方式不同分为髂骨块组(31例)和Cage组(29例),髂骨块组采用颈椎前路减压+椎体间自体髂骨植骨融合内固定术,Cage组采用颈椎前路减压+Cage植骨融合内固定术。比较两组患者手术前后围手术期、JOA评分、Odom’s临床疗效优良率及融合率、并发症发生率情况。结果60例患者随访8~15个月(平均12月)随访,未出现失访及漏访现象。Cage组患者的手术时间比髂骨块组短(P<0.05),Cage组患者术中出血量比髂骨块组少(P<0.05),两组患者住院天数比较差异无统计学意义(P>0.05)。两组患者术后3和12个月JOA评分均较术前改善(P均<0.05),术后3和12个月两组间JOA评分比较差异均无统计学意义(P均>0.05)。Cage组术后临床疗效优良率高于髂骨块组(P<0.05)。术后3个月髂骨块组较Cage组植骨融合率高(P<0.05),术后12个月两组植骨融合率和并发症发生率差异均无统计学意义(P均>0.05)。结论Cage组手术操作相对简单,出血量较少,不存在供骨区疼痛的问题,临床疗效满意,是治疗脊髓型颈椎病的较好方法。

Objective To evaluate the bone graft fusion rate and clinical efficacy of two kinds of anterior cervical surgery in the treatment of cervspondylotic myelopathy to provide theoretical reference basis for clinical treatment.Methods From March 2010 to March 2014,60 cases with cervical spondylotic myelopathy were divided into autologous ilium group and Cage group respectively.The 31 cases in autologous ilium group underwent anterior decompression and fusion procedures with autogenous iliac crest graft,and 29 cases in Cage group underwent anterior decompression and fusion procedures with Cage crest graft.Two kinds of anterior surgery were performed by the same group of physicians.Comparing bone graft fusion rate and clinical efficacy of two kinds of anterior cervical surgery at different times.Results For all cases,the mean follow-up period was 12 months(range 8-15 months)without loss of visitor.The operative time of patients in the Cage group was shorter than that in the autologous ilium group(P<0.05),and the intraoperative blood loss in patients in the Cage group was less than that in the autologous ilium group(P<0.05).There was no statistically significant difference in the length of hospital stay between the two groups(P>0.05).The postoperative JOA score and the rate of good clinical efficacy evaluation(Odom’s standard)were obviously improved.The postoperative JOA improvement rates of two groups were not statistically different between two groups(P>0.05).The excellent and good rate of Cage group was higher than autologous ilium group(P<0.05).Two groups of patients with postoperative 3 months of follow-up,the bone graft fusion rate of autologous ilium group was higher than Cage group(P<0.05).After 12 months,the fusion rate of two groups showed no statistical significances between two groups(P all>0.05).There was no significant difference in the incidence of complications of the last follow-up.Conclusion The surgery of Cage group is relatively simple,with no donor area pain,so Cage crest graft is the better method for the treatment of cervical spondylotic myelopathy.