分期前后路联合手术治疗多节段脊髓型颈椎病的临床分析  

Clinical analysis of stage combined anterior and posterior operation in the treatment of multi segmental cervical spondylotic myelopathy

作　　者：福嘉欣[1,2] 夏英鹏[3] 江汉[2] 江毅[2] 肖联平[2] 田永刚[2] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市第三中心医院骨科 [3]天津市人民医院脊柱外三科

出　　处：《临床医学》2015年第6期4-6,共3页Clinical Medicine

摘　　要：目的探讨分期前后联合手术治疗多节段脊髓型颈椎病的治疗效果。方法本研究分期进行颈椎前后路手术,即首先行后路椎板减压或单开门椎管扩大成形,后行前路短节段经椎间隙或椎体次全切除减压联合治疗多节段脊髓型颈椎病患者28例,手术前后根据日本骨科协会评估分数（JOA）进行评分,随访12~120个月。通过JOA评分的改善情况,Odom’s分级随访结果及颈椎活动度的变化三方面对比单纯前路或单纯后路多节段脊髓型颈椎病的治疗效果。结果采用前后路联合组第1次术后JOA评分为（12.40±0.65）分,第二次术后JOA评分为（14.05±0.19）分,改善率为76.31%,差异有统计学意义（t=0.014,P〈0.05）。分别对比三种不同方式术后Odom’s分级进行评价,前后路联合组优良率为80.9%,三组对比差异有统计学意义（u=0.024,Z〈0.05）。结论分期前后路联合治疗多节段脊髓型颈椎病可充分改善患者的神经功能恢复,可得到比单纯前路及后路手术更好的减压效果,并避免了单纯后路减压破坏整体脊柱的稳定性和单纯前路减压整体颈椎活动度的丢失,降低了手术风险,减少术后并发症的发生。Objective To investigate the effects of stage combined anterior and posterior operation on multi segmental cervical spondylotic myelopathy. Methods Twenty-eight multi segmental cervical spondylotic myelopathy patients were treated by the stages combined anterior and posterior operationat,and were given the posterior decompression or single door laminoplasty,then received the short segment after anterior vertebra clearance or corpectomy decompression. The scores were assessed according to the Japanese Orthopaedic Association（ JOA） assessment scores before and after operation,and all the cases were followed-up for12- 120 months. Compared the effects of simple anterior and simple posterior operation from three aspects： improvement of JOA score,the followed-up results of Odom＇s and the change of cervical activity. Results The JOA score of the first postoperative in combined anterior and posterior group was 12. 40 ± 0. 65,and 14. 05 ± 0. 19 of the second operation,the improvement rate was76. 31%,the difference was statistically significant（ t = 0. 014,P〈0. 05）. Three different ways were compared postoperatively.The Odom＇s grade was evaluated of the three different operation methods,combined anterior and posterior group,the excellent and good rate of combined group was 80. 9%. The differences were statistically significant. Conclusion The stage combined anterior and posterior operation in the treatment of multi segmental cervical spondylotic myelopathy can fully improve the recovery of neurological function,get better decompression effect than simple anterior and posterior operation,and avoid damaging the whole spinal stability of simple posterior decompression and the loss of activity of cervical vertebra of simple anterior decompression,reduce the operation risk and the occurrence of postoperative complications.

关 键 词：分期 前后路联合 多节段 脊髓型颈椎病 

分 类 号：R687.3[医药卫生—骨科学]