颈椎前路两种手术方式治疗多节段脊髓型颈椎病

摘要

Objective To evaluate of two different anterior cervical surgical treatment of multilevel cervical spondylotic myelopathy clinical efficacy. Methods Selected three or more segments accumulated of the spinal cord-type cervical spondylosis of 36 patients, of which 18 cases were treated with a single sub-segment corpectomy internal fixation + other disc excision alone bone graft and internal fixation( A group ), which was segmental decompression and bone graft fixation; 18 patients with two or more vertebral bodies and fusion with subtotal long segment plate fixation( B group ), which was long segment decompression and bone graft fixation. Two groups were compared with operative time , operative blood loss, hospital stay, fusion rate, neurological improvement rate and cervical physiological curvature of the situation. Results Operation time, blood loss, hospital stay in A group were lower than those in B group( P ＜0. 05 ). Internal fixations of both groups had not problem postoperative. Cobb’s angle compared with preoperative improvement between the two groups was statistically significant( P ＜ 0. 05 ) ; B group anglec loss rate of postoperative follow-up was higher than that in A group( P ＜0. 05 ); Bone graft fusion occurred after 6 months in two groups, JOA scores had improvement in the two groups and there was no statistically significant ( P ＞0. 05 ). Conclusion Both methods attain good clinical results; Anterior cervical discectomy combined with corpectomy treatment of multi-segmental cervical spondylotic myeiopathy , with relatively less blood loss, shorter operative time,less trauma, retain more vertebral bone.which is a good operation method.%目的 评价颈椎前路分节段减压植骨内固定术和长节段减压植骨固定术治疗多节段脊髓型颈椎病的临床疗效.方法 选择累及≥3个节段的脊髓型颈椎病患者36例,其中18例采用分节段单个椎体次全切除植骨内固定+其它椎间盘单独切除植骨内固定术(A组),即分节段减压植骨内固定术;另18例采用≥2个椎体一起次全切除植骨融合长节段钢板内固定术(B组),即长节段减压植骨固定术.比较两组手术时间、术中出血量、住院时间、植骨融合率、神经功能改善率、颈椎生理弧度情况.结果 A组手术时间、术中出血量、住院时间均低于B组,差异有统计学意义(P＜0.05).随访时内固定均未发生问题,Cobb角均较术前改善(P＜0.05);术后随访角度丢失率B组高于A组(P＜0.05);两组植骨融合率在术后6个月时为100%,A组术后4个月植骨均融合,B组有2例到术后6个月时融合.两组JOA评分较术前均有改善,组间差异无统计学意义(P＞0.05).结论 两种方法治疗多节段脊髓型颈椎病均可获得满意的临床疗效;颈椎间盘切除联合椎体次全切除植骨内固定术具有相对出血少、手术时间短、创伤小、椎体骨质保留多优点,是一种较好的手术方式.