前路椎间隙减压融合术治疗多节段脊髓型颈椎病的疗效分析

Efficacy analysis of anterior cervical decompression fusion in the treatment of multilevel cervical spondylotic myelopathy

目的比较前路椎间隙减压融合术和后路椎管扩大成形术治疗多节段脊髓型颈椎病(MCSM)的疗效。方法选择2017年1月至2019年1月在上海德济医院诊治的MCSM患者86例,按照手术方式不同分为观察组和对照组,每组各43例。观察组予以前路椎间隙减压融合术,对照组予以后路椎管扩大成形术。比较两组手术疗效、手术时间、术中出血量、术后引流量、住院时间、术后颈椎功能障碍指数(NDI)及并发症发生情况,观察两组手术前后日本骨科协会腰痛评分表(JOA)评分、融合节段Cobb角、椎体活动度、颈椎椎管矢状径和颈椎曲度指数(CCI)水平的变化。结果观察组的总有效率为86.05%,明显高于对照组的65.12%(P<0.05);两组术后并发症发生率比较,差异无统计学意义(P>0.05);观察组的术后引流量、住院时间和术后NDI评分均少于或低于对照组(P<0.05),而两组的手术时间和术中出血量比较,差异均无统计学意义(P>0.05);两组手术前JOA评分、融合节段Cobb角、椎体活动度、颈椎椎管矢状径和CCI水平比较,差异均无统计学意义(P>0.05),手术后两组椎体活动度和CCI水平较治疗前降低(P<0.05),而JOA评分、融合节段Cobb角、颈椎椎管矢状径较手术前升高(P<0.05),观察组的椎体活动度和CCI水平低于对照组(P<0.05),JOA评分、融合节段Cobb角、颈椎椎管矢状径高于对照组(P<0.05)。结论与后路椎管扩大成形术比较,前路椎间隙减压融合术治疗MCSM近期疗效更好。

Objective To compare the efficacy of anterior cervical decompression fusion and posterior spinal canal angioplasty in the treatment of multilevel cervical spondylotic myelopathy(MCSM).Methods A total of 86 patients with MCSM treated in Shanghai Deji Hospital from January 2017 to January 2019 were selected and divided into observation group and control group according to different surgical methods,with 43 cases in each group.The observation group was treated with anterior cervical decompression fusion,and the control group was treated with posterior spinal canal angioplasty.The efficacy,operation time,intraoperative blood loss,postoperative drainage,hospital stay,postoperative neck disability index(NDI)and complications were compared in two groups,and changes of the Japan Orthopaedic Association(JOA)scores,fusion segment Cobb angle,vertebral motion,cervical spinal canal sagittal diameter and cervical curvature index(CCI)were observed in two groups before and after surgery.Results The total effective rate in observation group was 86.05%,which was significantly higher than 65.12%in control group(P<0.05).There was no significant difference in postoperative complications between the two groups(P>0.05).The postoperative drainage volume,hospital stay,and postoperative NDI scores in observation group were significantly shorter or less than those in control group(P<0.05),but there was no significant difference in the operation time and intraoperative blood loss between the two groups(P>0.05).There was no significant difference in JOA scores,fused segment Cobb angle,vertebral activity,cervical spinal canal sagittal diameter and CCI between two groups before surgery(P>0.05).After surgery,the vertebral activity and CCI levels in two groups were significantly lower than those before treatment(P<0.05),while the JOA scores,fusion segment Cobb angles,and cervical spinal canal sagittal diameter were significantly higher than those before surgery(P<0.05).The vertebral activity and CCI in the observation group were lower than those in the control group(P<0.05),and JOA scores,fusion segment Cobb angle and cervical spinal canal sagittal diameter were higher than those in the control group(P<0.05).Conclusion Compared with posterior spinal canal angioplasty,recent efficacy of anterior cervical decompression fusion for the treatment of MCSM is better.