颈椎前后路手术治疗嵌夹型脊髓型颈椎病的疗效比较

Effect comparation of the anterior and posterior approach on the pinching cervical spondylotic myelopathy

目的回顾性分析颈椎前路减压融合内固定术和后路椎管成形术治疗嵌夹型脊髓型颈椎病的临床疗效及并发症。方法回顾性分析73例嵌夹型脊髓型颈椎病。根据治疗方法分组,采用颈椎前路减压植骨融合术39例为前路组,采用颈椎后路椎管成形结合微型钛板内固定34例为后路组,比较两组患者手术时间、术中出血量,术后引流量、住院时间,以及两组在术前、术后3个月、6个月、1年及末次随访的颈痛视觉模拟评分法(VAS)、日本骨科协会(JOA)评分和颈椎Cobb角,评定临床疗效并记录术后并发症。结果所有患者手术顺利,均获得随访。前路组的手术时间明显长于后路组,手术出血量、术后引流量均少于后路组,住院时间短于后路组(t分别=-8.13、6.72、5.68、9.23,P均<0.05)。在随访过程中,术后3个月时前路组在JOA评分和颈椎曲度变化与后路组比较,差异均无统计学意义(t分别=1.58、1.32,P均>0.05);但前路组颈痛VAS评分明显低于后路组,差异有统计学意义(t=3.41,P<0.05)。两组均未出现松动、移位、断裂等内固定相关并发症。结论颈椎前路减压融合术和后路椎管成形术都能够有效地改善嵌夹型脊髓型颈椎病的神经功能,但部分患者仍需结合病情进行选择性再次减压。在无明显手术禁忌情况下,前后路手术的决定因素包括颈椎稳定性,脊髓压迫来源,颈椎管狭窄程度,颈椎的生理弧度以及后纵韧带钙化程度。

Objective To comparative the effect of anterior cervical decompression and fusion and posterior laminoplasty plus titanium miniplate on multilevel pinching cervical spondylotic myelopathy.Methods A data of 73 patients with multilevel pinching cervical spondylotic myelopathy was retrospectively analyzed.According to the treatment methods,39 patients treated with anterior cervical decompression and fusion were enrolled as anterior group and 34 patients with posterior laminoplasty plus titanium miniplate fixation were enrolled as posterior group.The operative time,intraoperative blood loss,postoperative drainage volume,hospitalization time were recorded,and visual analogue scale(VAS),Japanese orthopedics association(JOA)scores and cervical Cobb angle before surgery,3 months,6 months,and 1 year after surgery and the last follow-up were compared between the two groups.Clinical efficacy was assessed and postoperative complications were recorded.Results All patients were followed-up without any complications of severe nerve and vascular injuries.Compared to the posterior group,the operative time of anterior group was longer,the operative blood loss and postoperative drainage volume were less,and the hospitalization time was shorter(t=-8.13,6.72,5.68,9.23,P<0.05).The JOA score and cervical Cobb angle between two groups at 3 months after operation were not statistically different(t=1.58,1.32,P>0.05).The VAS of anterior group were lower than that posterior group(t=3.41,P<0.05).No complications related to internal fixation such as loosening,displacement and fracture occurred in both groups.Conclusion Anterior cervical decompression and fusion and posterior laminoplasty can effectively improve the neurological function of multilevel pinching cervical spondylotic myelopathy,but some cases still need selective re-decompression combined with the condition of the disease.Compared with posterior approach,anterior approach is superior for the treatment of multilevel pinching cervical spondylotic myelopathy with less trauma and maintenance of cervical curvature.