放大镜辅助与常规开放颈椎前路减压治疗脊髓型颈椎病临床效果的比较  

Clinical results following anterior cervical decompression for the treatment of cervical spondylotic myelopathy：comparison of ioupes and traditional methods

作　　者：温世锋[1,4] 尹庆水[2] 李菊根[3] 郭东明[4] 徐中和[4] 肖文德[4] 陈珊茗[4] 张光明[4] 

机构地区：[1]南方医科大学研究生院,广州510515 [2]广州军区广州总医院骨科医院 [3]广州医学院第二附属医院骨科 [4]广州市第一人民医院

出　　处：《中华显微外科杂志》2013年第3期232-236,共5页Chinese Journal of Microsurgery

摘　　要：目的比较放大镜辅助下与常规开放颈椎前路减压治疗脊髓型颈椎病临床疗效的差别。方法回顾性分析2009年6月至2012年9月问收治的59例脊髓型颈椎病患者，分别接受放大镜辅助下（A组）和常规开放（B组）颈椎椎体次全切除手术减压治疗29例和30例。通过比较两组病例的住院费用、术后住院天数、手术时间、术中出血量、并发症、手术前及随访时的神经功能JOA评分及改善率，评估两种手术方法的临床疗效。结果所有患者均获得随访3～39个月，平均（24．64±10．07）个月。两组患者术前JOA评分、术后住院天数、住院费用等方面比较差异均无统计学意义（P〉0．05）。与B组比较，A组术中m血量明显减少，手术时间及术后并发症发生率明显降低，差异均有统计学意义（P〈0．05）。随访时，A组JOA评分为14．76±1．35，高于B组的14．03±1．40（P〈0．05），A组JOA改善率平均为（62．54±14．70）％，较B组的（51．68±14．75）％明显增加（P〈0．05）；46例患者（A组21例，B组25例）进行了颈椎MRI复查，A组颈椎椎管及脊髓最狭窄处面积较术前分别增加（52．8±11．8）％和（43．3±15．6）％，均明显高于B组的（41．8±14．2）％和（21．4±7．8）％（P〈0．05）。结论放大镜辅助下颈椎前路手术视野更清晰，可有效减少出血量，减少手术并发症，取得更好的临床效果。Objective To compare the clinical results between loupes and traditional methods which used in anterior cervical decompression for the treatment of cervical spondylotie myelopathy （CSM）. Methods A retrospective study of 59 patients with CSM who had undergone cervical decompression from June 2010 to September 2012 was performed. Twenty-nine patients underwent surgery by loupes and 30 patients by traditional methods respectively. Clinical results were assessed by comparing the following parameters between patients who were in the two groups： length of postoperative stay, hospitalization cost, operative time, and estimated blood loss during operation, complications, Japanese Orthopaedic Association （JOA） score and JOA recovery rate. Results All patients were followed up from 3 to 39 months with an average of （ 24. 64 ± 10. 07 ） months. No statistically significant differences were identified in preoperative JOA score, hospitalization cost, and length of stay （P 〉 0.05 ）. Statistically significant differences were identified in estimated blood loss during operation, operative time and complications. When follow up, group A experienced the greater improvement than group B in neurological function, both in follow up JOA （ 14. 76 ± 1.35 vs 14. 03 ± 1.40, P 〈 0.05） and JOA recovery rate （62. 54 ± 14.70 vs 51.68 ± 14. 75, P 〈0.05） ; Forty-six cases （21 in group A and 25 in group B） received post-operative MRI check, the narrowest area of spinal canal and spinal cord in group A increased （52. 8 ± 11.8 ） % and （43.3± 15.6）%, was higher than that （41.8 ± 14.2）% and （21.4 ±7.8）% in group B respectively （ P 〈 0. 05 ）. Conclusion Loupes can provide relatively more clear and comfortable vision for the anterior cervicaldecompression surgery. It can decrease blood loss, reduce complications, which can ensure better clinical results.

关 键 词：颈椎病 脊髓型 颈椎前路手术 显微外科 治疗效果 

分 类 号：R687[医药卫生—骨科学]