Ⅰ期前后路内固定治疗多节段脊髓型颈椎病  

The Combined Anteriorc and Posterior Approach for the Treatment of Multilevel Cervical Spondylotic Myelopathy

作　　者：吴刚 陈岗[2] 

机构地区：[1]陕西省铜川市人民医院南院骨外科,铜川727001 [2]江苏省苏北人民医院骨科,扬州225001

出　　处：《中国现代手术学杂志》2015年第4期285-288,共4页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨Ⅰ期前后路联合内固定治疗多节段脊髓型颈椎病(CSM)的临床疗效。方法选取2008年1月至2013年1月本院脊椎外科收治128例CSM患者为研究对象,根据患者术式将其分为前路椎体减压植骨融合术(A组)48例,经后路椎板成形椎管扩大术(B组)38例以及前后路联合手术(C组)42例,观察不同术式手术疗效。结果与A组比较,B、C组术中出血量较高,手术时间、术后下床运动时间、平均住院时间较长(P<0.05),而B、C组比较无统计学差异(P>0.05)。三组患者出院时及随访结束时JOA评分、Cobb角较术前均得到改善,但C组改善效果优于A、B组,差异有统计学意义(P<0.05)。随访结束时C组融合率为95.24%、优良率为90.48%,显著高于A组62.5%、41.67%及B组73.68%、47.37%,差异有统计学意义(P<0.05)。结论Ⅰ期前后路联合内固定治疗CSM疗效显著,但患者手术创伤性较大,需严格掌握患者手术适应证,以提高患者手术疗效,降低手术风险。Objective To investigate the clinical efficacy of combined anterior and posterior approach for the treatment of multilevel cervical spondylotic myelopathy（ CSM）. Methods 128 cases of CSM were divided into anterior decompression and fusion group（ A group,n = 38）,posterior expansive laminoplasty group（ group B,n = 38）,and combined anterior and posterior approach group（ group C,n = 42） from January 2008 to January 2013. The effects of different approaches were analyzed. Results The blood loss of group C were more than group A（ P〈0. 05）. The operative time,postoperative ambulation exercise time,average length of hospital stay of group C were longer than that of group A（ P〈0. 05）,but had no difference with group B. The JOA score and Cobb angle of three groups at the discharging and the end of follow-up were better than in hospital（ P〈0. 05）. And the JOA score and Cobb angle of group C were higher than group A and B. The fusion rate of group A,B and C was 62. 5%,73. 68%,and 95. 24% respectively,and the good effect rate was 41. 67%,47. 37%,and 90. 48%. Both the fusion rate and the good effect rate of group C were better than group A and B（ P〈0. 05）. Conclusion The combined anterior and posterior approach for the treatment of multilevel cervical spondylotic myelopathy is effective,with high incidence of postoperative complication. It should be used in the condition of strict indication control.

关 键 词：椎管成形术 减压术 外科 颈椎病 

分 类 号：R687.3[医药卫生—骨科学]