前路与后路手术治疗成人无骨折脱位颈脊髓损伤

Anterior procedure versus posterior surgery for spinal cord injury without radiographic abnormality in adult

[目的]比较颈椎前路减压融合术(anterior cervical decompression and fusion, ACDF)与后路双开门扩张椎板成形术(bilateral open-door cervical expansive laminoplasty, BODEL)治疗成人无骨折脱位型脊髓损伤的临床效果。[方法]回顾性分析2014年1月—2019年12月本院骨科手术治疗无影像异常的颈脊髓损伤52例患者的临床资料,其中,28例采用ACDF,24例采用BODEL。比较两组患者围手术期、随访与影像资料。[结果] ACDF组手术时间、术中出血量及住院时间显著优于BODEL组(P<0.05)。与术后3个月相比,末次随访时两组患者NDI评分显著减少(P<0.05),JOA评分显著增加(P<0.05)。相应时间点,两组NDI和JOA评分的差异无统计学意义(P>0.05)。随时间推移,两组患者ASIA神经功能评级均显著改善(P<0.05);相应时间点两组ASIA神经功能评级的差异均无统计学意义(P>0.05)。影像方面,与术前相比,末次随访时两组患者的椎管矢状径、椎管横径和C2~C7前凸角均明显改善(P<0.05)。相应时间点,两组间上述影像测量指标的差异均无统计学意义(P>0.05)。[结论]相较于BODEL,ACDF治疗成人无影像异常的颈脊髓损伤更为简便、安全。

[Objective] To compare clinical outcomes of anterior cervical decompression and fusion(ACDF) versus posterior bilateral open-door cervical expansive laminoplasty(BODEL) for spinal cord injury without radiographic abnormality in adult. [Methods] From January 2014 to December 2019, 52 patients with cervical spinal cord injury without radiographic abnormality were treated surgically in our hospital. Among them, 28 patients received ACDF, while the other 24 patients underwent BODEL. The perioperative, follow-up and imaging data were compared between the two groups. [Results] The ACDF group was significantly better than the BODEL group in operation time, intraoperative blood loss and hospital stay(P<0.05). Compared with 3 months after operation, the NDI scores significantly reduced(P<0.05), whereas the JOA scores significantly increased in both groups at the latest follow up(P<0.05). At any corresponding time point,the differences in NDI and JOA scores between the two groups were not statistically significant(P>0.05). The ASIA neurological function grades improved significantly over time in both groups(P<0.05). However, there was no statistically significant difference in the ASIA grade between the two groups at any corresponding time points(P>0.05). In terms of imaging evaluation, the sagittal diameter and the transverse diameter of the spinal canal, as well as the C2-C7 lordosis angle significantly improved in both groups at the latest follow up compared with those preoperatively(P<0.05). At any corresponding time point, the differences in the abovementioned imaging measurement indexes between the two groups were not statistically significant(P>0.05). [Conclusion] Compared with BODEL, ACDF is simpler and safer technique for cervical spinal cord injury without radiographic abnormality in adult.