三种颈椎前路融合术对双节段颈椎病的疗效比较  

作　　者：詹碧水[1] 蒋雪生[1] 周国顺[1] 陆骞[1] 

机构地区：[1]浙江省湖州市中心医院,313000

出　　处：《浙江临床医学》2018年第3期418-420,共3页Zhejiang Clinical Medical Journal

摘　　要：目的比较分析颈椎前路三种融合手术治疗双节段颈椎病的临床效果。方法2008年1月至2015年1月手术治疗双节段颈椎病患者226例，根据手术方式分为A、B、C三组，对比分析三组手术时间、出血量、术后引流量、住院时间、手术前、后日本骨科协会（JOA）评分、视觉模拟疼痛评分（VAS）、融合节段高度、颈椎曲度改变情况、术后并发症等，并进行统计学分析。结果随访1-8年，三组在住院时间差异无统计学意义（P〉0．05）；C组手术时间、术中出血量和引流量，比A组明显减少（P〈0．05）；IOA评分、VAS评分、融合节段高度和颈椎曲度在术后5d和末次随访时与术前比较均获得一定改善（P〈0．05）；B组和C组改善和维持融合节段高度与A组比较差异有统计学意义（P〈0.05），B组改善和维持颈椎曲度优于A组和C组（P〈0．05）。术后总并发症发生率比较，三组间差异有统计学意义，C组术后5d吞咽困难和末次随访时邻近节段退变比A组和B组明显减少（P〈0．05）。结论三种手术方式均能够取得满意的神经功能改善和融合率，A组能够获得彻底减压，B组能够维持比较理想的颈椎曲度和高度，C组能够降低术中损伤，减少术后吞咽困难和邻近节段退变发生，应该根据患者具体情况，采用最优化的治疗方式。Objective To compare the clinical outcome of three types of anterior cervical decompression and fusion for two-level cervical spondylotic nryelopathy. Methods The clinical outcome of 226 patients underwent surgery for the treatment of degenerative two-level cervical spondylotic myelopathy were retrospectively reviewed between January 2008 and January 2015 and divided into Group A, B, C based on surgery mode. The operation time, intraoperative blood loss, postoperative drainage volume, hospital stays, JOA （Japanese Orthopedic Association ） scores, VAS （Visual Analog Scale ） scores, the cervical lordosis, the height of fused segments and postoperative complications were respectively compared and analyzed statistically. Results The follow-up duration was 1-8 years. There was no significant difference in hospital stays in all groups （ P〉0.05 ） . In operation time, perioperative blood loss and postoperative drainage volume Group C showed significant difference compared with Group A （P〈0.05） . JOA score, VAS score, the height of fused segments and the cervical lordosis made a significant improvement at 5 day and at last follow- up postoperatively compared with that before operation （P〈0.05） . In improving and maintaining the height of fused segments, Group B and Group C had a significant difference comparing with Group A （ P〈0.05 ） , and Group B made a better improvement than Group A and Group C in improving and maintaining the cervical lordosis. In comparison of the postoperative complications, there was a significant difference in all groups dysphagia at 5 days of post-operation and adjacent segment degeneration at last follow-up in group C was significantly less than in group A and group B （ P〈0.05 ） . Conclusions The three types of anterior cervical decompression and fusion are effective procedures for improving the neurological outcome and the fusion rate of patients of two-level cervical spondylotic myelopathy. Group A can obtain better decompression, Group B carl improve an

关 键 词：颈椎病 脊柱融合术 椎间盘切除术 椎体次全切除术 

分 类 号：R687.3[医药卫生—骨科学]