两种方法治疗神经根型颈椎病的疗效比较

Comparison of curative effect of two kinds of methods in the treatment of cervical spondylotic radiculopathy

目的 比较颈后路椎间孔扩大减压术(PKHT)和颈前路减压融合术(ACDF)治疗神经根型颈椎病的疗效。方法 将101例神经根型颈椎病患者根据手术方法不同分为PKHT组(50例)和ACDF组(51例)。比较两组手术情况、颈部及上肢疼痛VAS评分、颈椎活动度(ROM)、颈椎功能障碍指数(NDI)及SF-36评分,根据改良MacNab评分标准评价临床疗效。结果 患者均获得随访,时间13~30个月。手术时间两组比较差异无统计学意义(P> 0.05)。术中出血量及住院时间PKHT组少(短)于ACDF组(P<0.05)。上肢疼痛VAS评分术后各时段两组比较差异均无统计学意义(P> 0.05)。颈部疼痛VAS评分、颈椎ROM:术后2周及3个月PKHT组均优于ACDF组(P<0.05);术后12个月两组比较差异均无统计学意义(P> 0.05)。NDI、SF-36评分:术后2周及3、12个月PKHT组均优于ACDF组(P<0.05)。末次随访疗效优良率PKHT组高于ACDF组(P<0.05)。结论 与ACDF相比,PKHT治疗神经根型颈椎病具有创伤小、出血少、恢复快、疗效好等优点。

Objective To compare the efficacy of posterior cervical keyhole technique(PKHT) and anterior cervical decompression and fusion(ACDF) in the treatment of cervical spondylotic radiculopathy(CSR).Methods The 101cases of CSR were divided into PKHT group(n= 50) and ACDF group(n= 51),according to different surgical methods. The operation conditions, pain VAS of neck and upper limb,cervical range of motion(ROM), neck dysfunction index(NDI) and SF-36 score were compared between the two groups, and the clinical efficacy was evaluated according to the modified MacNab standard.Results All patients were followed up for 13 ~ 30 months. The operation time had no significant difference between the two groups(P> 0. 05). The volume of intraoperative blood loss and length of hospital stay in PKHT group were less(shorter) than those in ACDF group(P< 0. 05). There was no statistical significance in pain VAS of upper limb pain between the two groups at different postoperative periods(P>0. 05). Pain VAS of the neck and cervical ROM:at 2 weeks and 3 months after surgery,they were better in PKHT group than those in the ACDF group(P< 0. 05), but there was no statistical significance between the two groups at 12months after surgery(P> 0. 05). NDI and SF-36 scores in PKHT group were better than those in ACDF group at 2weeks,3,12 months postoperation(P< 0. 05). At the last follow-up,the excellent-good rate of curative effect in PKHT group was higher than that in ACDF group(P< 0. 05).Conclusions Compared with ACDF,PKHT has the advantages of less trauma, less bleeding,fast recovery and good efficacy in the treatment of CSR.