颈椎体前移与颈后路全椎板切除减压术治疗颈脊髓损伤的疗效对比

Comparison of the outcomes of anterior controllable antedisplacement and fusion and posterior cervical laminectomy decompression and fusion in the treatment of cervical spinal cord injury

目的比较颈椎体前移与颈后路全椎板切除减压术治疗颈脊髓损伤的临床疗效。方法纳入颈椎外伤伴颈脊髓损伤的患者62例,按手术方式分为颈椎体前移减压术(ACAF)组(30例)和颈后路全椎板切除减压术(PCLD)组(32例)。比较2组患者术中出血量、手术时间、术后引流量、住院时间减压节段数及并发症差异。采用美国脊椎损伤学会(ASIA)评分评价2组患者术前及术后2周、2年的脊髓神经功能情况。结果ACAF组术后出现椎管内血肿1例,PCLD组出现术后感染2例和脑脊液漏2例,经对症处理后均顺利出院。PCLD组患者术中出血量、术后引流量和住院时间均大/长于ACAF组(P<0.05);2组患者减压节段数、手术时间比较,差异无统计学意义(P>0.05)。2组患者术前ASIA评分比较差异无统计学意义(P>0.05),2组患者术后2年脊髓神经功能较术前及术后2周均明显恢复(P<0.05),但组间比较差异无统计学意义(P>0.05)。结论ACAF和PCLD均可有效治疗颈脊髓损伤,但在控制术中出血量、术后引流量、住院时间方面,ACAF更优。

Objective To compare the clinical outcomes of anterior controllable antedisplacement and fusion and posterior cervical laminectomy decompression and fusion for cervical spinal cord injury.Methods A total of 62 patients with cervical spine trauma and cervical spinal cord injury were included and divided into the anterior controllable antedisplacement and fusion(ACAF)group(30 cases)and posterior cervical laminectomy decompression and fusion(PCLD)group(32 cases)according to their surgical methods.The intraoperative blood loss,operation time,postoperative drainage volume,hospital stay,number of vertebral decompression segments and complications between the two groups were compared.The American Spinal Injury Association(ASIA)score was used to evaluate the spinal nerve function before surgery,2 weeks and 2 years after surgery.Results There was 1 case of intraspinal hematoma after surgery in the ACAF group,2 cases of infection and 2 cases of cerebrospinal fluid leakage after surgery in the PCLD group,and all of them were discharged smoothly after symptomatic treatment.The intraoperative blood loss,postoperative drainage volume and hospital stay in the PCLD group were larger/longer than those in the ACAF group(P<0.05),and there was no statistically significant difference in the number of vertebral decompression segments or operation time between the two groups(P>0.05).There was no statistically significant difference in the ASIA score before surgery between the two groups(P>0.05),the spinal nerve functions 2 years after surgery of the two groups were recovered obviously compared with those before surgery and 2 weeks after surgery(P<0.05),but there was no statistically significant difference between the two groups(P>0.05).Conclusion Both ACAF and PCLD can effectively treat cervical spinal cord injury,but ACAF is better in controlling intraoperative blood loss,postoperative drainage volume and hospital stay.