颈前路“杂交式”与颈后路治疗多节段脊髓型颈椎病的临床比较

摘要

目的:比较颈前路“杂交式”减压融合与颈后路全椎板减压侧块内固定术治疗多节段脊髓型颈椎病的临床特点.方法:选择36例行“杂交式”颈前路治疗及33例行颈后路全椎板减压侧块内固定术治疗的多节段脊髓型颈椎病患者,观察两组患者手术前后一般资料、出血量、手术时间、颈椎生理曲度、JOA评分及并发症的发生情况.结果:两组患者术前的一般资料包括年龄(颈前路组:56.23±7.64岁,颈后路组:55.76±8.18岁)、性别(颈前路组:22男/14女,颈后路组:20男/13女)、颈椎生理曲度D值(颈前路组:7.41±3.14,颈后路组:8.19± 2.74)、JOA评分(颈前路组:9.08± 1.09分,颈后路组:8.82±1.26分)、病程(颈前路组:17.24±7.36月,颈后路组:15.75± 5.78月)和受累节段(颈前路组:3.11±0.26个,颈后路组:3.24± 0.39个)比较差异均无统计学意义(P＞0.05).与颈后路相比,颈前路的术中出血量(颈前路组:221.79±178.02mL,颈后路组:483.07± 434.25mL)更少,差异有统计学意义(P＜0.05),手术时间(颈前路组:196.54± 51.88min,颈后路组:175.12± 54.93min)更长,但差异无统计学意义(P＞0.05).随着时间的延长,颈前路组患者颈椎生理曲度和JOA评分逐渐增大,而颈后路组患者椎生理曲度减少,JOA评分逐渐增大,差异有统计学意义(P＜0.05).颈前路组出现植骨未融合、声音嘶哑和脑脊漏液,颈后路组发生轴性疼痛和C5神经根麻痹,但两组患者并发症的发生率比较差异无统计学意义(颈前路组:13.89％,颈后路组:12.12％)(P＞0.05).结论:颈前路“杂交式”减压融合与颈后路全椎板减压侧块内固定术在治疗多节段脊髓型颈椎病上各有优点,临床根据患者的情况而采取合适的治疗方式.%Objective:To compare the therapeutic characteristics of anterior hybrid decompression and posterior cervical posterior laminectomy in the treatment of multilevel cervical spondylotic myelopathy.Methods:Thirty six cases of multilevel cervical spondylotic myelopathy patients treated by anterior hybrid decompression and thirty three cases of multilevel cervical spondylotic myelopathy patients treated by posterior cervical posterior laminectomy were involved.The general information,bleeding amount,operative time,cervical curvature D value,JOA score and incidence of postoperative complications of the two groups before and after surgery were compared.Results:There was no significant difference in the general information among the two groups(P＞0.05),including age (anterior group:56.23± 7.64 years old,posterior group:55.76± 8.18 years old),sex (anterior group:22 males/14 females,posterior group:20 males/13 females),cervical curvature D value (anterior group:7.41± 3.14,posterior group:8.19± 2.74),JOA score (anterior group:9.08± 1.09 scores,posterior group:8.82± 1.26 scores),disease course (anterior group:17.24± 7.36 months,posterior group:15.75± 5.78 months) and affected segment (anterior group:3.11 ± 0.26 segments,posterior group:3.24± 0.39 segments).The the amount of bleeding in the anterior group (anterior approach:221.79± 178.02 ml,posterior group:483.07± 434.25 ml) was lower than that of the posterior group(P＜0.05).The operative time (anterior group:196.54± 51.88 mins,posterior group:175.12± 54.93 mins) was longer,but there was no significant difference (P＞0.05).The cervical curvature D value and JOA score of posterior group were increased with the extension of surgery time.However,the cervical curvature D value of posterior group was decreased,but JOA score was increased.The incidence of bone unfinished,hoarseness and cerebrospinal fluid leakage were found in the anterior group,and axial pain and C5 nerve root paralysis were found in the posterior group.But there was no significant difference in the incidence of complications between the two groups (anterior group 14.89％,posterior group:12.12％)(P＞0.05).Conclusions:Anterior hybrid decompression and posterior cervical posterior laminectomy had their own advantages in the treatment of multilevel cervical spondylotic myelopathy.,The appropriate treatment should be taken according to the condition of patients.