后路单开门联合椎间孔切开术治疗混合型颈椎病

摘要

目的：探讨后路单开门联合椎间孔切开术治疗混合型颈椎病的效果及其安全性。方法选取2012年1月至2014年1月我院收治的70例混合型颈椎病患者，签订患者知情同意书后将其随机分为观察组和对照组，观察组采用后路单开门联合椎间孔切开术，对照组采用前路减压融合术，比较2组患者的手术时间、术中出血量以及术后日本骨科协会评分（JOA 评分）、颈椎功能障碍指数量表评分（NDI 评分），拍摄颈椎正、侧位片，测量患者的颈椎曲度以及颈椎活动度。结果2组患者术后 JOA 评分、颈椎曲度、颈椎活动度比较无明显差异（P ＞0．05）；观察组的手术时间及术中出血量明显少于对照组；在 NDI 评分方面，观察组除了提物和开车得分高于对照组外，其余5个项目评分组间比较无明显差异（P ＞0．05）。观察组并发症的发生率为10．81％（4／37），对照组为24．42％（8／33），组间比较差异有统计学意义（χ2＝3．428，P ＜0．05）。结论后路单开门联合椎间孔切开术治疗混合型颈椎病效果好，且手术时间短，术中出血少，并发症的发生率低，是一种安全有效的手术方式。%Objective To study the clinical efficacy and safety of posterior laminoplasty combined with foraminotomy in the treatment of mixed cervical spondylosis.Methods A total of 70 patients with mixed type cervical spondylosis from January 2012 to January 2014 in our hospital were randomly divided into observation group and control group.Patients in observation group received posterior laminoplasty com-bined with foraminotomy,and patients in control group received anterior cervical discectomy and fusion surgery.The operation time,intraoper-ative blood lossing,postoperative JOA scores and NDI scores between two groups were compared.The cervical curvature and range of motion were measured by X-ray.Results There was no significant difference in postoperative JOA scores,cervical curvature and range of motion be-tween two groups(P >0.05).The operative time and intraoperative blood loss of observation group was less than those of control group,the difference was no significance.The NDI scores of carrying and drive in observation group were higher than those in control group,while the NDI scores of other items between two groups had no significant difference(P >0.05).The incidence of complications in observation group was 10.81% (4 /37),the control group was 24.42% (8 /33),the difference between two groups was statistically significant,(χ2 =3.428, P <0.05).Conclusion The posterior laminoplasty combined with foraminotomy have good clinical effect for mixed type cervical spondylosis with advantages of a shorter operation time,simple operation,less intraoperative bleeding,lower incidence of complications,which is a kind of safe and effective surgical method.