摘要
目的探讨采用颈前路椎体次全切除融合术(ACCF)和颈后路椎板切除侧块螺钉固定术治疗多节段脊髓型颈椎病(MCSM)的临床疗效。方法选择2016年2月至2019年2月于我院收治的74例MCSM患者,按随机数字表法分为A组(n=37)和B组(n=37)进行对比研究。A组行颈前路椎体次全切除融合术(ACCF),B组行后路椎板切除侧块螺钉固定术。比较两组患者的手术时长、术中的出血量、术后并发症发生率、日本骨科学会(JOA)评分和颈椎曲度指数(CCI),进行疗效分析。结果两组手术时长比较,差异无统计学意义(P>0.05)。A组术中的出血量、术后住院时间均少于B组,差异有统计学意义(P<0.05)。两组的术后3个月、术后1年JOA评分与其术前比较,差异有统计学意义(P<0.05)。两组间的术后3个月、术后1年JOA评分及JOA改善率比较,差异无统计学意义(P>0.05)。两组间的术后1年JOA改善优良率比较,差异无统计学意义(P>0.05)。两组的术后3个月、术后1年CCI与其术前比较,差异有统计学意义(P<0.05)。两组间的术后3个月、术后1年CCI比较,差异无统计学意义(P>0.05)。两组间的并发症发生率比较,差异无统计学意义(P>0.05)。结论ACCF和颈后路椎板切除侧块螺钉固定术治疗MCSM均可获得良好的手术疗效,两者在手术时长、颈椎曲度指数、脊髓神经功能改善、并发症方面无显著差异,临床应根据患者综合因素个性化选择术式。
Objective To investigate the clinical efficacy of anterior cervical corpectomy and fusion(ACCF)and posterior cervical laminectomy with lateral mass screw fixation for the treatment of multilevel cervical spondylotic myelopathy(MCSM).Methods A total of 74 MCSM patients admitted to our hospital from February 2016 to February 2019 were selected and divided into group A and group B according to the random numer table for comparative study.Group A(n=37)underwent ACCF,while group B(n=37)underwent posterior cervical laminectomy with lateral mass screw fixation.The efficacy was analyzed by comparing the surgery time,intraoperative blood loss,postoperative complication rate,Japan Orthopaedic Association(JOA)score and Cervical Curvature Index(CCI)of the two groups of patients.Results There was no statistically significant difference in the surgery time between the two groups(P>0.05).The intraoperative blood loss and postoperative length of stay in group A were less than those in group B,with statistically significant differences(P<0.05).The JOA scores of the two groups at 3 months after surgery and 1 year after surgery were significantly different from those before surgery(P<0.05);there were no statistically significant differences in JOA score and JOA improvement rate at 3 months after surgery and 1 year after surgery between the two groups(P>0.05).There was no statistically significant difference in the excellent and good rate of JOA improvement at 1 year after surgery between the two groups(P>0.05).The CCIs of the two groups at 3 months after surgery and 1 year after surgery were significantly different from those before surgery(P<0.05);there were no statistically significant differences in CCI at 3 months after surgery and 1 year after surgery between the two groups(P>0.05).There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).Conclusion Both ACCF and posterior cervical laminectomy with lateral mass screw fixation can obtain good surgical results for MCSM.There are no significant differences between the two in terms of surgery time,Cervical Curvature Index,improvement of spinal nerve function,and complications.In the clinical setting,the surgery method should be selected in a personalized way according to the comprehensive factors of patients.
作者
曾广吾
董时纯
陈健
ZENG Guangwu;DONG Shichun;CHEN Jian(Department of Spine and Joint Surgery,Guidong People's Hospital of Guangxi Zhuang Autonomous Region,Guangxi,Wuzhou 543001,China)
出处
《中国医药科学》
2021年第13期190-194,共5页
China Medicine And Pharmacy
基金
广西壮族自治区贺州市科学研究与技术开发计划项目(贺科转1809019)。
关键词
脊髓型颈椎病
多节段
颈椎前路
颈椎后路
Cervical spondylotic myelopathy
Multilevel
Anterior cervical approach
Posterior cervical approach
