前路椎间盘减压融合治疗对多节段颈椎病患者JOA评分和颈椎活动度的影响

摘要

Objective To analyze the effect of anterior decompression with fusion on JOA score and the active degree of cervical vertebra in patients with multilevel cervical myelopathy.Methods Totally 130 patients with multilevel cervical myelopathy from August 2010 to January 2016 in Quzhou Kecheng Hospital were randomly divided into observation group and control group,with 65 cases in each group.The observation group was treated with anterior cervical decompression with fusion;the control group was treated with subtotal vertebrectomy decompression and fusion.Operation data,JOA score and the active degree of cervical vertebra were analyzed.Results All patients were successfully operated;there were no serious intraoperative complications.The operation time,intraoperative blood loss and postoperative hospital stay in observation group were significantly lower than those in control group [(128 ± 26) min vs (165 ± 31) min,(161 ± 30) ml vs (319 ± 28) ml,(9.4 ± 1.7) d vs (13.7 ± 1.5) d] (P ＜ 0.05).The improvement rate of JOA score in observation group was significantly higher than that in control group[95.4％ (62/65) vs 83.1％ (54/65)] (P ＜ 0.05).The active degrees of cervical vertebra 3 months after operation were significantly lower than those before operation in observation group and control group [(26.4 ± 7.2) ° vs (35.0 ± 3.2) °,(30.6 ± 5.3) ° vs (35.2 ± 2.2) °] (P ＜ 0.05),and the active degree of cervical vertebra in observation group was significantly lower than that in control group (P ＜ 0.05).Conclusion Anterior decompression with fusion treating multilevel cervical myelopathy can reduce trauma,increase the JOA score,improve nerve function and promote vertebra activity.%目的 探讨前路椎间盘减压融合治疗对多节段颈椎病患者JOA评分和颈椎活动度的影响.方法 选取2010年8月至2016年1月于浙江省衢州市柯城区人民医院就诊的多节段颈椎病患者130例作为研究对象.完全随机分为观察组与对照组,各65例.观察组给予前路椎间盘减压融合治疗,对照组给予前路椎体次全切除减压融合治疗,比较2组的手术相关指标及手术前后的JOA评分和颈椎总活动度.结果 所有患者均顺利完成手术,无术中严重并发症发生.观察组手术时间、术后住院时间短于对照组,术中出血量少于对照组,差异均有统计学意义[(128±26) min比(165 ±31)min、(9.4±1.7)d比(13.7 ±1.5)d、(161±30)ml比(319 ±28)ml](均P＜0.05).观察组JOA评分改善率高于对照组,差异有统计学意义[95.4％(62/65)比83.1％(54/65)](P＜0.05).观察组与对照组术后3个月的颈椎总活动度分别为(26.4±7.2)°和(30.6±5.3)°,均明显低于术前的(35.0±3.2)°和(35.2±2.2)°,差异有统计学意义(P＜0.05),同时观察组术后的颈椎总活动度小于对照组,差异有统计学意义(P＜0.05).结论 前路椎间盘减压融合治疗多节段颈椎病患者能减少创伤,提高JOA评分,改善神经功能,促进颈椎总活动度的改善.