多节段脊髓型颈椎病前后不同手术入路的比较分析  

Analysis of effect of anterior and posterior surgical approach for multiplylevel cervical spondylotic myelopathy

作　　者：张冬生[1] 杨永宏[1] 楼肃亮[1] 朱江军[1] 

机构地区：[1]解放军第117医院(全军脊柱外科中心)骨一科,浙江省杭州市310013

出　　处：《中国骨与关节损伤杂志》2012年第9期780-782,共3页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨多节段脊髓型颈椎病(CSM)前后路不同术式的手术效果及各自的优缺点。方法回顾109例多节段CSM资料,前路组67例行分节段减压,钢板固定+(MC+)固定,后路组42例行单开门、颈椎管扩大成形(ARCH)微型钛板固定。比较两组的手术时间、失血量、手术前后JOA评分及远期轴性颈椎痛的发生率。结果平均随访32个月,手术时间前路组(127.01±33.44)min,后路组(118.61±22.28)min,差异无统计学意义(P>0.05);术中失血量前路组(316.42±150.35)ml,后路组(676.60±300.15)ml,差异有统计学意义(P<0.05);JOA评分前路组术前(9.34±2.03)分,术后(14.08±2.26)分,差异有统计学意义;后路组术前(9.17±2.03)分,术后(13.86±1.71)分,差异有统计学意义;两组比较差异无统计学意义(P>0.05);长期随访轴性颈椎痛前路组7例,后路组14例,差异有统计学意义(P<0.05)。结论通过对多节段CSM前后不同入路的分析,认为对多数患者应采用前路手术效果更加理想,远期随访轴性颈椎痛的发生率前路明显少于后路组,前路手术还可以减少C5神经根麻痹的发生。Objective To study the pros and cons of posterior or anterior approach cervical decompression surgery for multiplylevel cervical segments spondylotic myelopathy. Methods All of 109 patients with multiplylevel cervical spondylotic myelopathy who were conducted surgery were reviewed retrospectively. Sixty seven patients underwent surgery by anterior approach with segmental decompression, plate and MC-R fLxation while 42 patients underwent surgery by posterior approach with open-door laminoplasty and ARCH plate fixation. Time of the surgery, blood loss, JOA scores and long term incidence of axial pain were collected and compared. Results The mean follow-up time was 32 months. Operation time of anterior approach was （127.01±33.44）min and （118.61±22.28）min for posterior group. There was no statistical significance between two groups（P 〉0.05）. JOA scores of anterior approach significantly improved from （9.34±2.03） to （14.08±2.26） after operation. There was statistical significance between two groups （P 〈0.05）. JOA scores of posterior approach also significantly improved from （9.17±2.03） to （13.86±1.71）. There was statistical significance between two groups（P 〈0.05）. JOA scores of postoperation had no statistical significance between two appreachs. Seven cases of anterior approach suffered axial pain better than and 14 cases of posterior after the long time follow up. There was statistical significance between two groups（P〈0.05）. Conclusion By comparing and analyzing two methods.for the multiplylevel cervical spondylotic myelopathy, we suggest that the most of the patients should conduct the anterior approach. The incidence of axial pain of the anterior approach is lower than posterior approach. The posterior approach should be only conducted for the patients with long level OPLL or degeneration with whole cervical.

关 键 词：多节段 颈椎病 外科手术 椎板成形术 

分 类 号：R681.55[医药卫生—骨科学]