不同入路方式在脊髓型颈椎病伴后凸畸形手术中的应用效果对比

Comparison of Different Approaches in the Treatment of Cervical Spondylotic Myelopathy with Kyphosis

目的比较不同入路方式在脊髓型颈椎病伴后凸畸形手术中的应用效果。方法选取2016年9月至2018年3月收治的60例脊髓型颈椎病伴后凸畸形患者,根据随机数字表法分为颈椎前路组和颈椎后路组,每组30例。其中,颈椎前路组采用前路零切迹椎间融合术,颈椎后路组采用颈椎后路椎板切除融合术,比较两组患者的临床效果,评估手术方式的选择。结果颈椎后路组的术中出血量和融合节数均高于颈椎前路组(P<0.05),两组患者的手术时间、神经功能JOA评分无明显差异(P>0.05);两组术后NDI指数和VAS评分均较术前明显下降(P<0.05),且术后NDI指数和VAS评分颈椎前路组明显低于颈椎后路组(P<0.05);两组术后Cobb角和颈椎活动度均较术前明显改善(P<0.05),且术后Cobb角和颈椎活动度的改善颈椎后路组明显优于颈椎前路组(P<0.05)。结论在脊髓型颈椎病伴后凸畸形手术中,采用颈椎前路和颈椎后路入路均能够起到较好的治疗效果,颈椎前路术式在减少手术创伤及术后疼痛方面优于颈椎后路,颈椎后路术式对减少颈椎活动度的丧失方面效果优于颈椎前路。

Objective To compare the effect of different approaches in the treatment of cervical spondylotic myelopathy with kyphosis.Methods Sixty patients with cervical spondylotic myelopathy with kyphosis were enrolled from September 2016 to March 2018.They were divided into anterior cervical spine group(n=30)and posterior cervical spine group(n=30)according to the random number table method.Anterior zero-notch intervertebral fusion was performed in the anterior cervical spine group,while posterior cervical laminectomy and fusion were performed in the posterior cervical spine group.The clinical effects of the two groups were compared to evaluate the choice of surgical method.Results Compared with the anterior cervical spine group,the amount of intraoperative blood loss and the number of fusions in the posterior cervical spine group were higher(P<0.05).There was no significant difference in the operation time and neurological JOA score between the two groups(P>0.05).Postoperative NDI index and VAS score in both groups were significantly lower than those before operation(P<0.05),and postoperative NDI index and VAS score in the anterior cervical spine group were significantly lower than those in the posterior cervical spine group(P<0.05).Postoperative Cobb's Angle and cervical range of motion were significantly improved in both groups(P<0.05),and postoperative improvement of Cobb's Angle and cervical range of motion in the posterior cervical spine group was significantly better than that in the anterior cervical spine group(P<0.05).Conclusion In the treatment of cervical spondylotic myelopathy with kyphosis,the anterior approach and posterior approach of the cervical spine can both achieve good therapeutic effect.The anterior approach is better than the posterior approach in reducing surgical trauma and postoperative pain.The posterior approach is superior to the anterior approach in reducing the loss of cervical vertebra activity.