脊髓型颈椎病两种减压术后疗效的随访观察  

Prognosis of cervical spondylotic myelopathy treated with two decompression approaches

作　　者：巩腾[1] 王沛[1] 冯世庆[1] 

机构地区：[1]天津医科大学总医院骨科,天津300052

出　　处：《临床骨科杂志》2008年第6期489-492,共4页Journal of Clinical Orthopaedics

基　　金：国家自然科学基金资助项目(编号:30271313);天津市科委自然科学基金资助项目(编号:043609011)

摘　　要：目的探讨脊髓型颈椎病前、后入路减压术式疗效。方法274例脊髓型颈椎病患者中,116例行前路减压植骨内固定,158例采用后路全椎板切除减压。依术前病程分组行脊髓功能JOA评分,体感神经诱发电位(SEP)及颈椎主动活动度检查作对比观察。结果随访时间2～5年,病程较短(<1年)者两种减压术前JOA评分和SEP各参数间差异无显著性(P>0.05),而病程较长(>1年)者两种减压术前差异有显著性(P<0.01)。两种减压术后JOA评分改善率及SEP各参数变动率差异亦有显著性(P<0.05)。前路减压术后3个月、2年参数间差异有显著性(P<0.05),而后路术后两时期间差异无显著性(P>0.05)。两者术后2年颈椎主动活动度差异有显著性(P<0.05)。结论①术后脊髓功能恢复程度与术前病程长短及髓内缺血变性严重程度有一定相关性;②前路减压单纯去除颈髓前方致压病灶效果较好,后路椎板切除因直接扩大颈椎管有效容积,间接解除脊髓压迫的弓弦效应产生及对颈椎主动活动度影响甚微,其术后疗效较同期前路术更佳。Objective To investigate the prognosis of two decompression approaches for cervical spondylotic myelopathy. Methods 274 cases were divided into two groups. 116 cases underwent decompression by anterior decompression,fusion and internal fixation with titanium screws and plate and 158 underwent posterior laminectomy. All cases were evaluated and compared with the evaluation systems of Japanese Orthopaedic Association （JOA） Score, somato- sensary evoked potential （SEP） and initiative range of motion. Results All cases were followed up for 2 - 5 years. For the cases with less than 1 year duration, the JOA scores and 5EP were no significant different between the 2 groups （ P 〉 0. 05 ） preoperatively. For those with over 1 year duration,the JOA scores and SEP were significant different between the 2 groups （P 〈 0.01 ） preoperatively. After operation, the JOA scores improvement rates and SEP changes were significant different （ P 〈 0. 05 ）. In anterior group, they were significant different in 3 months and 2 years （ P 〈0. 05 ）. In the posterior group ,they were not significant different（ P 〉0. 05 ）. The rang of motion was signif- icant different between the 2 groups （ P 〈 0. 05 ）. Conclusions （1） The amplitude of functional recovery has close -correlations with preoperative course of disease and severity of spinal cord ischemia ;（2） The efficiency of posterior decompression is better than anterior approach because of simultaneously enlarging available space within vertebral canal, hardly influencing initial motion of cervical vertebrae and the generation of ＇ bow-string potency＇ which may indirectly relieve mechanical pressure on spinal cord at the corresponding periods. However,anterior decompression merely removes pathological tissue located in anterior wall of vertebral canal.

关 键 词：颈椎病 减压术 外科 椎板切除术 体感诱发电位 JOA评分 主动活动度 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]