单开门椎管成形术与全椎板切除减压固定融合术治疗脊髓型颈椎病的疗效比较

Comparison of clinical efficacy between single-door laminoplasty and laminectomy decompression and fusion with internal fixation for cervical spondylotic myelopathy

目的比较单开门椎管成形术与全椎板切除减压固定融合术治疗脊髓型颈椎病的临床疗效。方法回顾性分析自2007-10-2016-10诊治的151例脊髓型颈椎病,89例采用单开门椎管成形术治疗(观察组),62例采用全椎板切除减压固定融合术治疗(对照组)。比较2组术后并发症、手术时间、术中出血量以及末次随访时疼痛VAS评分、JOA评分、JOA评分改善率、CCI、ROM。结果151例均顺利完成手术并获得完整随访,随访时间12~40个月,平均30个月。观察组术后轴性症状数较对照组少,差异有统计学意义(P<0.05),2组术后出现C,神经根牵拉综合征数比较差异无统计学意义(P>0.05)。2组手术时间、术中出血量比较差异无统计学意义(P>0.05)。末次随访时2组疼痛VAS评分JOA评分、JOA评分改善率比较差异无统计学意义(P>0.05);观察组CCI较对照组小,ROM较对照组大,差异有统计学意义(P<0.05)。结论单开门椎管成形术与全椎板切除减压固定融合术治疗脊髓型颈椎病均可促进患者神经功能的恢复,能有效缓解术前疼痛。

Objective To investigate the clinical efficacy between single-door laminoplasty and laminectomy decompression and fusion with internal fixation to treat cervical spondylotic myelopathy.Methods A retrospective analysis of 151 cases of cervical spondylotic myelopathy diagnosed and treated from October 2007 to October 2016 was conducted,89 cases were treated with single-door spinal laminoplasty(observation group),and 62 cases were treated with laminectomy,decompression,fixation and fusion(control group).The postoperative complications,operation time,intraoperative blood loss and pain VAS score,JOA score,JOA score improvement rate,CCI,ROM at the last follow-up were compared between the two groups.Results All 151 cases successfully completed the operation and received complete follow-up.The follow-up time was 12-40 months,with an average of 30 months.The number of postoperative axial symptoms in the observation group was less than that in the control group,and the difference was statistically significant(P<0.05).The difference in the number of postoperative Cs nerve root traction syndromes in the two groups was not statistically significant(P>0.05).There was no significant difference in operation time and intraoperative blood loss between the two groups(P>0.05).At the last follow up,there was no significant difference in the improvement rate of pain VAS score,JOA score,and JOA score between the two groups(P>0.05);the observation group had a smaller CCI than the control group,and a larger ROM than the control group.The difference was statistically significant(P<0.05).Conclusion Both single-door laminoplasty and laminectomy decompression and fusion with internal fixation can promote recovery of neurological function in the patients and effectively relieve preoperative pain.