单纯前路与前后联合入路治疗退变性多节段脊髓型颈椎病的对比研究

Comparative Study on Effectiveness of Anterior and Anterior Combine Posterior for the Treatment of Degenerative Multilevel Cervical Spondylotic Myelopathy

目的比较前路多节段(≥3)颈椎间盘切除椎管减压植骨融合内固定(ACDF)与后路单开门椎管扩大成形(ELAP)联合ACDF治疗伴颈椎后凸、巨大椎间盘突出的退变性多节段脊髓型颈椎病的疗效。方法回顾性分析2014年1月至2019年1月于我院接受多节段ACDF或ELAP联合ACDF治疗的41例合并颈椎后凸畸形、巨大椎间盘突出的退变性多节段脊髓型颈椎病病人的临床资料,根据手术方式分为单纯前路组(21例)和前后联合入路组(20例),单纯前路组21例,男10例,女11例,年龄为(52.10±5.96)岁。前后联合入路组20例,男12例,女8例,年龄为(53.23±5.12)岁。记录病人手术时间、术中出血量、住院时间、疼痛视觉模拟量表(visual analogue scale,VAS)评分、日本骨科协会(Japanese Orthopedic Association,JOA)评分、Nurick评分、C_(2-7)Cobb角、局部后凸角(RK)、C_(2-7)矢状面垂直轴(SVA)。结果前后联合入路组手术时间、出血量大于单纯前路组(P<0.05)。两组住院时间的差异无统计学意义(P>0.05)。末次随访,两组VAS评分、Nurick评分均小于术前,JOA评分大于术前,差异均有统计学意义(P<0.05);前后联合入路组VAS评分、Nurick评分小于单纯前路组,JOA评分、JOA改善率大于单纯前路组,差异均有统计学意义(P<0.05)。两组C_(2-7)Cobb角、RK均大于术前(P<0.05),C_(2-7)SVA与术前比较,差异无统计学意义(P>0.05)。两组C_(2-7)Cobb角、RK、C_(2-7)SVA比较,差异无统计学意义(P>0.05)。结论多节段ACDF、ELAP联合ACDF治疗合并颈椎后凸畸形、巨大椎间盘突出的退变性多节段脊髓型颈椎病均可显著改善病人的临床症状及颈椎曲度。与多节段ACDF比较,ELAP联合ACDF虽然手术创伤大但术式更安全,病人的临床症状效果改善更好。

Objective To compare the efficacy of multilevel anterior cervical discectomy decompression and fusion(ACDF)and posterior single-door expansion laminoplasty combined with ACDF in the treatment of degenerative multilevel cervical spondylotic myelopathy accompanied with cervical kyphosis,compression from disc herniation and high occupying ratio greater than 50%.Methods The clinical and imaging data of patients with degenerative multilevel cervical spondylotic myelopathy accompanied with cervical kyphosis,disc herniation and high occupying ratio greater than 50%who were treated in our hospital from January 2014 to January 2019 were retrospectively analyzed.According to the surgical procedures,there were 21 cases in the anterior approach group,10 males and 11 females,aged(52.10±5.96)years,and 20 cases in the anterior and posterior combined approach group,12 males and 8 females,aged(53.23±5.12)years.The operation time,intraoperative bleeding,hospital stay,neck pain visual analogue scale(VAS),Japanese Orthopedic Association(JOA)score,Nurick score,C_(2-7)Cobb angle,region kyphosis angle(RK),C_(2-7)sagittal vertical axis(C_(2-7)SVA)preoperation and at the last follow-up were measured.Results The operation time was longer and intraoperative bleeding was greater in the anterior and posterior combined approach group than the anterior approach group(P<0.05).There was no significant difference in the hospital stay between the two groups.VAS scores and Nurick scores at the last follow-up were lower and JOA scores were higher than those preoperaton(P<0.05)in both groups.VAS score and Nurick score in the anterior and posterior combined approach group at the last follow-up were lower than those in the anterior approach group(P<0.05).JOA score and JOA improvement rate were greater in the anterior and posterior combined approach group than those in the anterior approach group(P<0.05).The C_(2-7)Cobb angle and RK at the last follow-up were increased as compared with those preoperation in both groups(P<0.05),and there was no significant difference in C_(2-7)SVA(P>0.05).The differences in the C_(2-7)Cobb angle,RK,and C_(2-7)SVA between the anterior and posterior combined approach group and the anterior approach group at the last follow-up showed no statistically significant difference(P>0.05).Conclusion Anterior approach,anterior and posterior combined approach can significantly improve the clinical symptoms and cervical curvature of patients with degenerative multilevel cervical spondylotic myelopathy complicated with cervical kyphosis,compression from disc herniation and high canal occupying ratio.Although anterior and posterior combined approach is more invasive,it is safer and the improvement of clinical symptoms is better than anterior approach.