前路减压融合术与后路单开门椎管扩大成形术治疗多节段脊髓型颈椎病的中期随访研究  

Comparison of the middle-term follow-up results between anterior decompression with fusion and posterior open-door laminoplasty for treatment of multi-level cervical spondylotic myelopathy

作　　者：关海山[1] 李承罡[1] 史洁[1] 田江华[1] 韩来春[1] Guan Haishan;Li Chenggang;Shi Jie;Tian Jianghua;Han Laichun(Department of Orthopaedics,the Second Hospital of Shanxi Medical University,Taiyuan 030001,China)

机构地区：[1]山西医科大学第二医院骨科,太原030001

出　　处：《中华骨科杂志》2019年第17期1044-1052,共9页Chinese Journal of Orthopaedics

摘　　要：目的观察颈椎前路减压融合术(anterior decompression with fusion,ADF)和后路单开门椎管扩大成形术(posterior open-door laminoplasty,LAMP)治疗多节段脊髓型颈椎病的中期疗效。方法回顾性收集2011年10月至2016年2月手术治疗多节段脊髓型颈椎病121例患者的病历资料。按手术方式不同分为ADF组和LAMP组。ADF组57例,男39例,女18例;年龄35~77岁,平均(58.8±10.1)岁;LAMP组64例,男48例,女16例;年龄28~82岁,平均(60.6±12.2)岁。主要观察指标为手术时间,术中出血量,术前、术后1、3、6、12和24个月及末次随访时日本骨科协会评分(Japanese Orthopaedic Association Scores,JOA)及改善率,疼痛视觉模拟评分(visual analogue scale, VAS),颈椎曲度,颈椎活动度(range of motion,ROM)以及LAMP术后脊髓前方残余压迫情况。记录轴性症状、C5神经根麻痹等并发症发生率。结果 ADF组平均随访(25.6±3.8)个月,LAMP组(27.3±4.1)个月。ADF组JOA评分术前平均(8.25±2.33)分,末次随访时(14.62±3.15)分,改善率为72.81%±11.32%;LAMP组JOA评分术前平均(8.84±3.65)分,末次随访时(12.97±4.32)分,改善率为66.54%±14.75%,两组末次随访时JOA评分(t=2.458,P=0.015)及改善率(t=3.172,P=0.002)的差异有统计学意义。术后1个月两组患者VAS评分均明显降低,ADF组为(1.92±0.75)分,LAMP组为(2.78±0.68)分,差异有统计学意义(t=2.364,P=0.021);至术后3个月两组间VAS评分的差异无统计学意义。ADF组术前颈椎曲度平均15.3°±7.6°,末次随访时19.2°±5.7°;LAMP组术前颈椎曲度平均16.8°±8.3°,末次随访时13.6°±4.3°,两组末次随访时颈椎曲度的差异有统计学意义(t=2.841,P=0.005)。两种术式均导致术后颈椎ROM下降,ADF组末次随访时15.2°±3.6°,LAMP组18.1°±4.1°,两组的差异有统计学意义(t=3.392,P=0.000),ADF组颈椎ROM丢失角度更多。术后并发症发生率ADF组为35.1%,LAMP组为20.3%,差异无统计学意义。LAMP组根据术后MRI有无脊髓前方残余压迫分Objective To compare the medium-term clinical and radiologic outcomes between anterior decompression with fusion (ADF) and posterior open-door laminoplasty (LAMP) in the treatment of multi-level cervical spondylotic myelopathy (MCSM). Methods Data of 121 patients meeting to inclusion criteria from October 2011 to February 2016 were retrospectively analyzed. All the patients were treated with ADF (ADF group, n=57) or LAMP (LAMP group, n=64) for MCSM. There were 39 males and 18 females in ADF group, aged from 35 to 77 years, with an average age of 58.8±10.1 years. And there were 64 cases in LAMP group, including 48 males and 16 females, aged from 28 to 82 years, with an average of 60.6±12.2 years. The operation time and blood loss were recorded. The clinical efficacy was evaluated by Japanese Orthopaedic Association Scores (JOA), improvement rate and visual analogue scale (VAS) before operation, 1, 3, 6, 12 and 24 months after operation and at the latest follow-up. At the same time, sagittal alignment of the C2-C7 lordotic angle and range of motion (ROM) in flexion and extension on plain X-rays was measured. Residual anterior compression to the spinal cord (ACS) in LAMP group on MRI was investigated. The incidence of complications such as axial symptoms and C5 nerve root paralysis were recorded. Results The average follow-up period was 25.6±3.8 months in ADF group and 27.3±4.1 months in LAMP group. Demographics were similar between the two groups. The mean JOA scores in ADF group increased from preoperative 8.25±2.33 to 14.62±3.15 at the latest follow-up, with an average recovery rate of 72.81%±11.32%. The mean JOA scores in LAMP group increased from preoperative 8.84±3.65 to 12.97±4.32 at the latest follow-up, with an average recovery rate of 66.54%±14.75%. The difference between two groups was statistically significant. Both of the VAS scores in the two groups decreased significantly at 1 month after the surgery, but the difference between the ADF group (1.92±0.75) and the LAMP group (2.78±0.68) was s

关 键 词：颈椎 脊髓压迫症 脊柱融合术 

分 类 号：R687.3[医药卫生—骨科学]