摘要
[目的]探讨分析颈前路椎间盘切除植骨融合术（anterior cervical discectomy and fusion,ACDF）或颈前路椎体次全切除融合术（anterior cervical corpectomy and fusion,ACCF）、颈后路椎管扩大成形术（posterior cervical laminoplasty,PCL）以及前后路联合手术治疗多节段脊髓型颈椎病（multilevel cervical spondylotic myelopathy,MCSM）的初期临床疗效。[方法]回顾性分析2009年1月~2012年1月在本院接受手术治疗,并完成至少2年随访的82例多节段脊髓型颈椎病患者。将37例行ACDF或ACCF的患者归入A组,将32例行PCL的患者纳入B组,其余13例行ACDF联合PCL的患者列为C组。比较分析A、B、C三组患者的手术时间、术中出血量、术后并发症发生率、日本矫形外科学会评分（Japan Orthopaedic Association,JOA）、JOA改善优良率、颈椎功能残障指数（neck disability index,NDI）和颈椎活动度（rang of motion,ROM）。[结果]截至末次随访时,A、B、C三组患者均获得良好的手术疗效。A组和B组的手术时间、术中出血量比较差异无统计学意义（P〉0.05）,均显著少于C组（P〈0.05）;三组患者的术后并发症发生率差异无统计学意义（P〉0.05）。所有患者术后JOA评分、NDI及ROM均较术前明显改善（P〈0.05）,术后6个月随访时,A组的NDI明显优于B组和C组（P〈0.05）,其余各项指标在三组间无差异（P〉0.05）。截至术后2年,B组的NDI劣于A组（P〈0.05）,而ROM则优于A组和C组（P〈0.05）,其余指标无统计学差异（P〉0.05）。[结论]此三种手术方法对治疗CSM均可获得良好的初期临床效果,前路手术在颈椎功能改善方面优于后路手术,而后路手术在颈椎活动度的丧失方面要优于前路手术和前后路联合手术。
[Objective] To investigate the early outcomes of patients with multilevel cervical spondylotic myelopathy（ MCSM） receiving anterior cervical discectomy and fusion（ ACDF）,anterior cervical corpectomy and fusion（ ACCF）,posterior cervical laminoplasty（ PCL）,or combined anterior and posterior approach. [Methods] The clinical data of 82 patients with MCSM receiving surgery in our hospital from January 2009 to January 2012 were retrospectively studied,and all patients were followed up for at least 2 years. Thirty- seven cases received ACDF or ACCF（ group A）,32 cases received PCL（ group B）,and the other 13 cases received ACDF combined with PCL（ group C）. The operation time,intraoperative blood loss,postoperative complications,JOA scores,NDI and ROM were comparatively studied. [Results] Group A and group B were not comparable regarding the operation time and intraoperative blood loss（ P 〉 0. 05）,which were less than those of group C（ P 〈 0. 05）.The postoperative complications were not significantly different among the three groups（ P 〉 0. 05）. After the surgery,the JOA score,NDI and ROM were all significantly improved（ P 〈 0. 05）. Group A had better improvement of NDI than the other two groups at 6 months follow up（ P 〈 0. 05）. At 2 years follow up,NDI of group B was inferior to that of group A（ P 〈 0. 05）,while ROM of group B was better than that of group A and group C（ P 〈 0. 05）. [Conclusion] All the three approaches are effective for the treatment of MCSM. Anterior surgery has advantages in cervical function improvement,while posterior surgery has advantages in the loss of cervical activity.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2015年第1期5-11,共7页
Orthopedic Journal of China
基金
广州市科技计划项目(编号:2011J4100052)
