显微镜辅助颈前路减压术对脊髓型颈椎病的治疗效果  

Curative effect of cervical spondylotic myelopathy treated by anterior cervical decompression

作　　者：陈昆 陈培基 周章南 蔡惠民 陈旭义 CHEN Kun;CHEN Peiji;ZHOU Zhangnan;CAI Huimin;CHEN Xuyi(Department of Orthopedics,No.910 Hospital of PLA,Quanzhou 362000,Fujian,China)

机构地区：[1]解放军第910医院骨科,福建泉州362000

出　　处：《贵州医科大学学报》2021年第10期1231-1235,共5页Journal of Guizhou Medical University

基　　金：国家自然科学基金(81760273)。

摘　　要：目的分析显微镜颈前路减压术与传统颈前路开放术式治疗脊髓型颈椎病的疗效。方法120例脊髓型颈椎病患者随机分为显微镜颈前路减压术组(显微组)和传统颈前路开放术式组(对照组),比较2组患者手术后1个月时的治疗效果,比较治疗前和治疗3个月时的颈椎功能、颈椎活动度和生活质量评分;观察两组患者治疗前和治疗1周、1个月、3个月及12个月时的神经功能缺失程度(NIHSS评分)、全颈椎生理曲度变化及疼痛程度,观察治疗3个月时2组患者术后并发症(硬膜损伤、神经根损伤、脊髓损伤、喉返神经损伤、伤口内血肿、内固定松动)的发生情况。结果治疗1月时疗效比较,显微组优于对照组(P<0.05);手术后3个月时,两组颈椎功能评分、颈椎活动度和生活质量评分均高于治疗前,治疗后显微组又高于同期对照组(P<0.05);2组患者在治疗后1周、1个月、3个月及12个月终访时的NIHSS评分均低于治疗前(P<0.05),治疗后显微组NIHSS评分低于同期对照组(P<0.05);2组患者在治疗后1周、1个月、3个月及12个月终访时全颈椎生理曲度均高于治疗前,治疗后显微组高于同期对照组(P<0.05);2组患者在治疗后1周、1个月、3个月及终访时VAS评分低于治疗前,治疗后显微组VAS评分低于同期对照组(P<0.05);两组患者术后3个月时硬膜损伤、血肿、内固定松动及总发生率等并发症发生率比较,显微组均低于低于对照组(P<0.05)。结论显微镜颈前路减压术治疗脊髓型颈椎病的临床疗效优于传统颈前路开放术。Objective To investigate the curative effect of anterior cervical decompression under microscope compared with traditional open anterior cervical decompression in the treatment of cervical spondylotic myelopathy.Methods One hundred and twenty patients with cervical spondylotic myelopathy were randomly divided into microscope anterior cervical decompression group(microscope group)and traditional anterior cervical open surgery group(control group).The curative effects of both groups 1 month after operation were compared,and the scores of cervical function,cervical mobility and quality of life before treatment and 3 months after treatment were compared.The degree of neurological deficit(NIHSS scores),the change of total cervical physiological curvature and the degree of pain were observed before and 1 week,1 month,3 months and 12 months after treatment.Complications of both groups at 3 rd month of treatment were observed(epidural damage,nerve root damage,spinal damage,recurrent laryngeal nerve damage,hematoma in wound,loose internal fixation).Results After 1 month of treatment,the curative effect of microscope was better than that of the control group(P<0.05).Three months after operation,the scores of cervical function,cervical mobility and quality of life in both groups were significantly higher than those before treatment(P<0.05).The NIHSS scores of both groups at the end of 1 week,1 month,3 months,and 12 months after treatment were lower than those before treatment(P<0.05).NIHSS scores of microscope group was lower than that of treatment group after treatment(P<0.05).The total cervical physiological curvature in both groups at the end of 1 week,1 month,3 months and 12 months after treatment were higher than those before treatment,microscope group was higher than that of control group after treatment(P<0.05).The VAS scores of both groups were lower than those before treatment at 1 week,1 month,3 months and the final visit,VAS scores of microscope group after treatment were lower than that of control group(P<0.05).

关 键 词：显微镜颈前路减压术 传统颈前路开放术式 脊髓型颈椎病 预后 

分 类 号：R322.3[医药卫生—人体解剖和组织胚胎学]