不同手术方式对多节段脊髓型颈椎病患者治疗效果和预后的影响

Effect of Different Surgical Approaches on the Treatment Outcome and Prognosis of Patients with Multi-Segmental Spinal Cord Cervical Spondylosis

目的:分析单纯后路手术与前后路联合手术两种术式对多节段脊髓型颈椎病患者的临床疗效、术后生活质量以及并发症,优化多节段脊髓型颈椎病患者外科治疗方案。方法:收集2016年1月至2021年12月期间我院多节段脊髓型颈椎病手术患者120例,按手术方式不同,分为单纯后路组(n=83)和前后路联合组(n=37)。记录两组患者手术时间、出血量、住院时间和住院费用;通过JOA、VRS、NRS评分和PF、RP、GH评分表,评估两组患者术后1、3、12个月神经功能恢复情况、生活质量;通过电话复诊记录患者满意度。结果:与后路手术组比较,在术后各随访时间点,前后路联合手术患者JOA评分、JOA恢复率、PF、RP、GH评分以及满意度无统计学差异(P>0.05);前后路联合组在术后3、12个月时NDI评分显著升高,有统计学差异(P<0.05);术后12个月时前后路联合组VRS、NRS评分高于单纯后路组,有统计学差异(P<0.05);前后路联合组术后轴性症状发生率显著增加(P<0.05);前后路联合组的手术时长、术中失血、术后住院时间和住院费用均显著增加(P<0.01)。与单纯后路组K线阴性患者相比,前后路联合组K线阴性患者术后1、12个月时NDI评分较高,有统计学差异(P<0.05)。结论:前后路联合手术在神经功能恢复、生活质量改善以及患者满意度方面并无显著优势,反而带来了更大的手术创伤、手术花费及并发症。

Objective:To analyze the effects of anterior-posterior approach and simple posterior approach on the clinical curative effect,quality of life and postoperative complications in patients with multi-level cervical spondylotic myelopathy and optimize the surgical treatment.Methods:One hundred and twenty patients with multi-segmental spinal cord type cervical spondylosis were collected from our hospital between January 2016 and December 2021,and were divided into the posterior-only group(n=83)and the combined anterior-posterior group(n=37)according to the different surgical approaches.The duration of surgery,bleeding,length of hospital stay and hospital costs were recorded for both groups;the recovery of neurological function and quality of life at 1,3 and 12 months after surgery were assessed by JOA,VRS and NRS scores and PF,RP and GH rating scales;patient satisfaction was recorded by telephone follow-up.Results:Compared with the posterior group,there were no statistical differences in JOA scores,JOA recovery rates,PF,RP,GH scores and satisfaction among patients with combined anterior and posterior surgery at each postoperative follow-up time point(P>0.05);NDI scores were significantly higher in the combined anterior and posterior group at 3 and 12 months postoperatively,with a statistical difference(P<0.05);VRS and NRS scores were statistically higher in the combined anterior-posterior group than in the posterior-only group(P<0.05);the incidence of postoperative axial symptoms was significantly higher in the combined anterior-posterior group(P<0.05);and the duration of surgery,intraoperative blood loss,postoperative hospital stay and hospital costs were significantly higher in the combined anterior-posterior group(P<0.01).NDI scores were statistically higher in the combined anterior-posterior group of K-line negative patients at 1 and 12 months postoperatively compared to the posterior-only group of K-line negative patients(p<0.05).Conclusion:Combined anterior and posterior surgery does not offer significant advantages in terms of neurological recovery,improvement in quality of life and patient satisfaction,but rather entails greater surgical trauma,cost and complications.