颈椎前后路手术治疗伴眩晕症状颈椎病的临床疗效  

Clinical Effect of Anterior and Posterior Cervical Surgery for Cervical Spondylosis with Vertigo

作　　者：赵思浩 柳根哲[1] 尹辛成[1] 孙佩宇[1] 陈超 郭雨霞 曾俊 李春根 ZHAO Sihao;LIU Genzhe;YIN Xincheng;SUN Peiyu;CHEN Chao;GUO Yuxia;ZENG Jun;LI Chungen(Department of Orthopedics,Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University,Beijing 100010,China;Beijing University of Chinese Medicine,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京中医医院骨科,北京100010 [2]北京中医药大学,北京100029

出　　处：《医学综述》2020年第17期3511-3515,3521,共6页Medical Recapitulate

摘　　要：目的探讨颈椎前路手术和后路单开门手术治疗伴眩晕症状颈椎病的临床疗效。方法收集2017年8月至2018年10月于首都医科大学附属北京中医医院骨科接受手术治疗的50例伴眩晕症状颈椎病患者的临床资料,根据手术方式不同分为前路组和后路组,每组25例。其中,前路组采用颈椎前路Hybrid手术(颈椎前路椎间盘切除融合术联合人工颈椎椎间盘置换术)治疗,后路组采用后路单开门手术治疗。记录并比较两组患者的围手术期指标、术前及术后12个月视觉模拟评分(VAS)、日本骨科协会评分(JOA)、眩晕残障程度评定量表(DHI)评分、眩晕症状改善率与并发症发生情况。结果前路组的术中出血量、住院时间显著少于后路组[(39±18)mL比(350±80)mL,(7.2±1.0)d比(16.1±0.9)d](P<0.01)。手术前后VAS、JOA及DHI评分的主效应差异有统计学意义(P<0.01);两组间VAS、JOA评分的主效应差异无统计学意义(P>0.05),DHI评分的主效应差异有统计学意义(P<0.05);JOA、DHI评分的时点间与组间存在交互作用(P<0.01),术后两组患者的JOA评分高于术前,DHI评分低于术前。前路组的眩晕症状总体改善率显著高于后路组[88.0%(22/25)比52.0%(13/25)](P<0.01)。前路组总并发症发生率为24.00%(6/25),后路组为20.00%(5/25),两组总并发症发生率比较差异无统计学意义(P>0.05)。结论当眩晕症状的发生与颈椎病相关时,采用颈椎前路手术治疗可取得较为满意的近期临床疗效,明显改善患者的眩晕症状。Objective To investigate the clinical efficacy of anterior cervical vertebra surgery and posterior single-door surgery in the treatment of cervical spondylosis with vertigo symptoms.Methods The clinical data of 50 patients with cervical spondylosis and vertigo symptoms treated with surgery in Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University between Aug.2017 and Oct.2018 were included.According to the different operation methods,the patients were divided into an anterior group and a posterior group,25 cases in each group.The anterior group was treated with hybrid operation(anterior cervical discectomy and fusion combined with artificial cervical disc replacement),and the posterior group was treated with posterior single approach operation.The perioperative indexes,preoperative and postoperative visual analogue scores(VAS),Japanese Orthopedic Association(JOA)scores,dizziness handicap inventory(DHI)scores,vertigo symptom improvement rate and complications of the two groups were recorded and compared.Results The blood loss and the hospitalization time of the anterior group were significantly less than those of the posterior group[(39±18)mL vs(350±80)mL,(7.2±1.0)d vs(16.1±0.9)d](P<0.01).The main effects of VAS,JOA and DHI scores before and after operation were statistically significant(P<0.01);the main effects of VAS and JOA scores between the two groups were not statistically significant(P>0.05),but the main effects of DHI scores were statistically significant(P<0.05);there was interaction between JOA and DHI scores between the two groups(P<0.01),the JOA score of the two groups after operation was higher than that before operation,and the DHI score was lower than that before operation.The overall improvement rate of vertigo symptoms in the anterior group was significantly higher than that in the posterior group[88.0%(22/25)vs 52.0%(13/25)](P<0.01).The total complication rate in the anterior group was 24.00%(6/25)and 20.00%(5/25)in the posterior group,there was no significa

关 键 词：颈椎病 颈椎前路手术 后路单开门手术 颈源性眩晕 

分 类 号：R681.5[医药卫生—骨科学]