颈椎间盘切除联合椎体次全切除植骨内固定治疗对多节段脊髓型颈椎病患者临床疗效神经功能及疼痛的影响

Effects of Cervical Discectomy Combined with Subtotal Vertebrectomyand Bone Graft Internal Fixation on Clinical Efficacy, NeurologicalFunction and Pain in the Treatment of Patients withMultilevel Cervical Spondylotic Myelopathy

目的:探究颈椎间盘切除联合椎体次全切除植骨内固定治疗对多节段脊髓型颈椎病(MCSM)患者临床疗效、神经功能及疼痛的影响。方法:选择103例MCSM患者,以后路单开门椎管成形微型钛板内固定术治疗的46例纳入对照组,以颈椎间盘切除联合椎体次全切除植骨内固定术治疗的57例纳入观察组,对比两组手术情况和住院时间、临床疗效、脊髓神经功能[日本骨科学会(JOA)评分]、颈椎功能障碍指数(NDI)、疼痛状况[视觉模拟评分法(VAS)]、颈椎活动度及并发症差异。结果:相比于对照组,观察组手术时间延长而术中出血量、住院时间减少,差异有统计学意义(P<0.05);观察组、对照组的治疗总有效率对应为71.93%(41/57)和69.56%(32/46),差异无统计学意义(P>0.05);术后6个月,两组JOA、NDI、疼痛VAS评分手术前后差值组间比较差异无统计学意义(P>0.05),观察组颈椎活动度手术前后差值大于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为5.26%,低于对照组的19.56%,差异有统计学意义(P<0.05)。结论:MCSM患者以颈椎间盘切除联合椎体次全切除植骨内固定治疗的短期疗效良好,可改善脊髓神经功能、疼痛状况,有利于维持患者颈椎活动度及减少术后并发症。

Objective:To explore the effects of cervical discectomy combined with subtotal vertebrectomy and bone graft internal fixation on clinical efficacy,neurological function and pain in patients with multilevel cervical spondylotic myelopathy(MCSM).Methods:A total of 103 patients with MCSM were selected.Among them,46 cases with posterior open-door spinal canaloplasty and mini-titanium plate internal fixation were included in control group,and 57 cases with cervical discectomy combined with subtotal vertebrectomy and bone graft internal fixation were included in observation group.The surgical situation and hospital stay,clinical efficacy,spinal cord nerve function[Japanese Orthopedics Association(JOA)score],Neck Disability Index(NDI),pain[Visual Analogue Scale(VAS)],cervical range of motion and complications were compared between the two groups.Results:Compared with control group,the surgical time was prolonged,intraoperative blood loss was reduced,and hospital stay was shortened in observation group(P<0.05).The total effective rate of treatment was 71.93%(41/57)in observation group and 69.56%(32/46)in control group respectively(P>0.05).At 6 months after surgery,comparison of differences of JOA score,NDI score and pain VAS score before and after surgery showed no statistical significance between the groups(P>0.05),and the difference of cervical range of motion before and after surgery in observation group was greater than that in control group(P<0.05).The incidence rate of postoperative complications of 5.26%in observation group was lower than 19.56%in control group(P<0.05).Conclusion:Cervical discectomy combined with subtotal vertebrectomy and bone graft internal fixation has short-term efficacy on patients with MCSM,and it can effectively improve the spinal cord nerve function and pain,and it is beneficial to maintaining the cervical range of motion and reducing the postoperative complications.