多节段脊髓型颈椎病治疗方式选择与疗效评价  

Treatment options and efficacy evaluation for multilevel cervical spondylotic myelopathy

作　　者：侯增涛[1] 赵爱琳[1] 郭传友[1] 陈伯华[2] 

机构地区：[1]青岛市市立医院,山东省青岛市266011 [2]青岛大学医学院附属医院,山东省青岛市266011

出　　处：《中国组织工程研究》2014年第40期6444-6450,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:手术是终止多节段脊髓型颈椎病病理进展,改善脊髓功能的重要措施,但如何选择最佳手术方式,减少并发症发生及提高临床疗效存在较大的争议。目的:系统性回顾多节段脊髓型颈椎病患者资料,评价单纯前入路、单纯后入路及一期后前联合入路治疗对患者颈椎曲率指数及脊髓功能恢复的影响。方法:选取2000年2月至2008年2月青岛大学附属医院和青岛市市立医院接受多节段脊髓型颈椎病手术治疗,符合纳入和排除标准的患者资料共148例,分为单纯前入路、单纯后入路及一期后前联合入路手术组,评估不同治疗方式治疗后患者功能恢复的差异。结果与结论:单纯后入路组患者治疗前颈椎曲率指数最高(P<0.01)。一期后前联合入路组患者治疗后颈椎曲率指数最高(P<0.01),而单纯前入路手术组患者治疗前后的颈椎曲率指数变化最为明显(P<0.01)。治疗后3组患者JOA评分差异无显著性意义(P>0.05),治疗后一期后前联合入路手术组患者JOA改善率与其他2组相比较差异有显著性意义(P<0.001)。3组患者治疗前后颈椎功能障碍指数和SF-36评分差异有显著性意义(P<0.05)。提示与单纯前路和单纯后路治疗方式比较,一期颈椎后前联合入路的减压方式在治疗多节段脊髓型颈椎病时,具有更可靠和有效的优势。BACKGROUND：Operation is an important measure to improve the function of spinal cord and to stop the pathological progress of multilevel cervical spondylotic myelopathy. There are controversies how to select the optimum operation mode, to reduce postoperative complications and to elevate clinical curative effects. 〈br〉 OBJECTIVE：To systematical y review patients’ profiles of multilevel cervical spondylotic myelopathy, and to evaluate the effects of simple anterior approach, simple posterior approach and one stage posterior anterior combined approach on cervical spinal curvature index and functional recovery in patients. 〈br〉 METHOD148 sample profiles of patients, who received multilevel cervical spondylotic myelopathy operation in The Affiliated Hospital of Qingdao University and Qingdao Municipal Hospital from February 2000 to February 2008, and met the inclusion and exclusion criteria, were selected. They were divided into simple anterior approach group, simple posterior approach group and one stage posterior anterior combined approach group. The differences in the functional recovery were assessed after treatment using different therapeutic methods. 〈br〉 RESULTS AND CONCLUSION：Cervical spinal curvature index was highest in the simple posterior approach group before treatment （P〈0.01）. Cervical spinal curvature index was highest in the one stage posterior anterior combined approach group after treatment （P〈0.01）. Changes in cervical spinal curvature index were most obvious in the simple anterior approach group before and after treatment （P〈0.01）. No significant difference in Japanese Orthopaedic Association Scores was detected among three groups after treatment （P〉0.05）. 〈br〉 Significant differences in improvement rate of Japanese Orthopaedic Association Scores were detectable after treatment between the one stage posterior anterior combined approach group and simple anterior approach and simple posterior approach groups （P〈0.001）. Significant differences in

关 键 词：植入物 脊柱植入物 脊髓 颈椎病 手术入路 疗效评价 脊髓型颈椎病 

分 类 号：R318[医药卫生—生物医学工程]