前路手术与后路单开门手术治疗脊髓型颈椎病的效果比较  

Comparison of the effects of anterior approach and posterior open door approach in the treatment of cervical spondylotic myelopathy

作　　者：王林杰[1] 孙国绍[1] 盛伟超[1] 吴青坡[1] 高延征[2] 

机构地区：[1]河南省平顶山市第一人民医院骨一科,467000 [2]河南省人民医院骨科

出　　处：《中国实用医刊》2016年第21期67-69,共3页Chinese Journal of Practical Medicine

摘　　要：目的比较前路手术与后路单开门手术治疗多节段脊髓型颈椎病的效果。方法选取2010年6月至2012年6月接受手术治疗的68例脊髓型颈椎病患者为研究对象，将患者随机分为A组与B组，每组34例。A组行颈前路椎体次全切除融合术（ACCF），B组行颈后路单开门椎管成形术（PCL），观察两组术中出血量、手术时间，术后随访1年记录视觉模拟评分法（VAS）评定患者的疼痛程度、颈椎活动度（ROM）、颈椎功能残障指数（DNI）评定颈椎功能改善情况、日本矫形外科学会评分（JOA）评定神经功能状况、JOA改善率及术后并发症。结果A组术后颈部疼痛程度[（O．86±0．43）分]低于B组[（1．37±1．05）分]，差异有统计学意义（P〈0．05）。两组术后DNI指数、ROM低于术前，JOA评分高于术前，差异有统计学意义（P〈0．05）；A组DNI指数[（28．36±5．67）分]、ROM[（42．12±7．54）°]明显低于B组[（36．25±6．11）分、（48．34±7．64）°]，差异有统计学意义（P〈0．05）；术后两组JOA改善优良率比较差异未见统计学意义（P〉0．05）。A组总并发症发生率（26．47％）显著低于B组（58．8％），差异有统计学意义（P〈0．05）。结论前路手术与后路单开门手术临床效果较好，前路手术颈椎功能改善情况、疼痛程度及总并发症发生率优于后路单开门手术，后路单开门手术颈椎活动度丧失情况优于前路手术。Objective To compare the effects of anterior approach and posterior open door ap- proach in the treatment of multi-segmental cervical spondylotic myelopathy. Methods Sixty-eight pa- tients with cervical spondylotic myelopathy who received surgical treatment between June 2010 and June 2012 were selected as the study objects and they were randomly divided into group A and group B with 34 cases in each group. Group A was treated by anterior cervical corpectomy fusion （ACCF） while group B was treated by posterior open door laminoplasty （PCL）. The intraoperative bleeding volume and operation time of the two groups were observed. With postoperative 1 year of follow-up, visual analogue score （VAS） was used to evaluate the pain degree and range of motion （ROM）. The cervical vertebral func- tion disability index （DNI） was used to evaluate the improvement of cervical function. Japanese Ortho- paedic Association score （JOA） was used to evaluate neurological function, JOA improvement rate and postoperative complications. Results The postoperative cervical pain of group A （0. 86 ± 0. 43 ） was lower than that of group B （ 1.37 ± 1.05 ） （P 〈 0. 05 ）. The postoperative DNI and ROM of group A and B were lower than before operation while JOA scores were higher than before operation （P 〈 0. 05 ）. The DNI （28.36±5.67） and ROM[ （42. 12 ±7.54） °] of group A were significantly lower than those of group B [ 36. 25 ± 6. 11, （48.34 ± 7.64）° ] （P 〈 0. 05 ）. There was no significant difference in excel- lent rate of JOA improvement between group A and group B after operation （ P 〉 0. 05 ）. The total inci- dence of complications in group A （26.47%） was significantly lower than that in group B （58.8%） （ P 〈 0. 05 ）. Conclusions The clinical effects of both anterior approach and posterior open-door ap- proach are good. The improvement of cervical function, pain degree and total incidence of complications of anterior approach are better than those of poste

关 键 词：前路手术 后路单开门手术 脊髓型颈椎病 效果 

分 类 号：R687.3[医药卫生—骨科学]