摘要
背景:目前多节段脊髓型颈椎病治疗的主要目的是解除脊髓的压迫,最大限度恢复颈椎的稳定性。目的:颈前路间盘切除植骨融合钛板内固定和颈后路单开门椎管成形治疗多节段脊髓型颈椎病的特点分析。方法:67例多节段脊髓型颈椎病患者按照治疗方式的不同分为2组:经颈前路间盘切除植骨融合钛板内固定组和经颈后路单开门椎管成形组。随访12个月观察两组患者颈椎活动度、颈椎曲度指数等颈椎的稳定性变化,进行轴性症状目测类比评分和JOA评分,分别记录手术时间、出血量及不良反应发生率。结果与结论:①两组内固定后均丢失部分颈椎活动度,颈后路单开门椎管成形组颈椎活动度丢失量多于颈前路间盘切除植骨融合钛板内固定组(P<0.05);②颈前路间盘切除植骨融合钛板内固定组内固定后颈椎曲度指数较内固定前更接近生理曲度(P<0.05),颈后路单开门椎管成形组未见明显改善;③两组轴性症状较治疗前明显缓解(P<0.05),颈后路单开门椎管成形组轴性症状缓解不如颈前路间盘切除植骨融合钛板内固定组(P<0.05);④两组神经功能比治疗前均得到明显改善(P<0.05),组间差异无显著性意义(P>0.05);(5)术中出血量颈后路单开门椎管成形组明显多于颈前路间盘切除植骨融合钛板内固定组(P<0.05);(6)颈前路间盘切除植骨融合钛板内固定组内固定后出现声音嘶哑、吞咽困难发生率为19%,颈后路单开门椎管成形组患者出现伤口感染、脑脊液漏、C5神经根麻痹发生率为9%;(7)结果说明,颈前路间盘切除植骨融合钛板内固定在恢复颈椎病变节段的生理曲度以及椎间隙高度,重建颈椎的稳定性方面好于颈后路单开门椎管成形,但有出现声音嘶哑和吞咽困难风险。后路单开门椎管成形操作较为简单,但出血量和并发症相对较多。因此需要根据临床医师的操作技巧和患者的实际情况慎重选择治疗方式。
BACKGROUND： The treatment of multilevel cervical spondylotic myelopathy （MCSM） aims at sustaining the spinal cord compression and restoring the stability of the cervical vertebrae at most.OBJECTIVE： To analyze the clinical characters of anterior cervical discectomy with fusion and expansive open-door laminoplasty for MCSM.METHODS： Sixty-seven patients with MCSM were divided into two groups, and treated with anterior cervical discectomy with fusion （group A） or posterior cervical expansive open-door laminoplasty （group B）. All the patients were followed up for 12 months, and the range of motion of cervical vertebrae, cervical curvature index were observed,as well as the Visual Analogue Scale and Japanese Orthopaedic Association scores were condueted. Moreover, the operation time, blood loss and adverse reactions were recorded.RESULTS AND CONCLUSION： （1） The loss of range of motion of the cervical vertebrae in the group B was significantly less than that in the group A （P 0.05）. （5） The intraoperative blood loss in the group B was significantly more than that in the group A （P 〈 0.05）. （6） The incidence of hoarseness and dysphagia in the group A was 19％. The incidence of wound infection, cerebrospinal fluid leakage and C5 nerve root palsy in the group B was 9％. （7） These results suggest that during choosing an appropriate method for MCSM,surgeons＇ skills and patients＇ situation should be considered.
出处
《中国组织工程研究》
CAS
北大核心
2017年第27期4306-4311,共6页
Chinese Journal of Tissue Engineering Research
