颈椎前后联合入路手术治疗多节段脊髓型颈椎病的临床研究

The clinical study of anterior and posterior combined approach for the treatment of multistage cervical spondylotic myelopathy

目的 比较颈椎前后联合入路手术与颈椎后路单开门椎管扩大成形术对前后受压型多节段脊髓型颈椎病的治疗效果。方法 回顾性分析2016年12月—2020年2月在锦州医科大学附属第三医院行手术治疗的60例前后受压型多节段脊髓型颈椎病患者的临床资料。根据不同的手术方式分为A、B两组,A组行颈椎后路单开门椎管扩大成形术;B组行颈椎前后联合入路手术。比较两组的手术时间、术中出血量、术后并发症;比较术前、术后1周、术后12个月的日本矫形外科学会(JOA)评分、视觉模拟评分法(VAS)评分及颈椎曲度D值。结果 B组治疗有效率高于A组(P <0.05);A组手术时间短于B组(P <0.05),出血量少于B组(P <0.05);B组术后JOA、VAS评分均高于A组(P <0.05);B组术后1周、术后12个月颈椎曲度D值高于A组(P <0.05);B组术后并发症发生率低于A组(P <0.05)。结论 颈椎前后联合入路手术治疗前后受压型多节段脊髓型颈椎病有效率更高,效果显著,值得临床应用与推广。

Objective To compare the therapeutic effectiveness of anterior-posterior combined approach surgery with posterior cervical laminoplasty in the treatment of multi-segmental cervical spondylotic myelopathy with anterior and posterior compression.Methods A retrospective analysis of clinical data from 60 patients with multi-segmental cervical spondylotic myelopathy with anterior and posterior compression who underwent surgery between December 2016 and February 2020 at the Third Affiliated Hospital of Jinzhou Medical University.Patients were divided into two groups(groups A and B)based on the surgical approach.Group A underwent posterior cervical laminoplasty,while group B underwent anterior-posterior combined approach surgery.Surgical duration,intraoperative blood loss,postoperative complications,preoperative and postoperative 1-week,as well as 12-month Japanese Orthopedic Association(JOA)scores,Visual Analog Scale(VAS)scores,and cervical curvature(D value)were compared between the two groups.Results Group B had a higher treatment efficacy compared to group A(P<0.05).Group A had a shorter surgical duration and lower intraoperative blood loss compared to group B(P<0.05).group B had higher postoperative JOA and VAS scores compared to group A(P<0.05).Additionally,group B exhibited higher cervical curvature(D value)at 1 week and 12 months postoperatively(P<0.05),along with a lower rate of postoperative complications compared to group A(P<0.05).Conclusion Anterior-posterior combined approach surgery is more effective in treating multi-segmental cervical spondylotic myelopathy with anterior and posterior compression,yielding significantly improved outcomes.This approach is worthy of clinical application and promotion.