前后入路联合手术对脊髓型颈椎病患者脊髓功能恢复的影响  

anterior-posterior combined surgery on spinal cord functional recovery in patients with cervical spondylotic

作　　者：何琼 罗嫚 马妍 HE Qiong;LUO Man;MA Yan(Operation Room,Hubei Hospital of Integrated Traditional Chinese and Western Medicine,Wuhan Hubei 430000,China;Department of Orthopedics,Wuhan Orthopedic Hospital of Integrated Traditional Chinese and Western Medicine(Affiliated Hospital of Wuhan Institute of Physical Education),Wuhan Hubei 430079,China)

机构地区：[1]湖北省中西医结合医院手术室,湖北武汉430000 [2]武汉中西医结合骨科医院(武汉体育学院附属医院)骨科,湖北武汉430079

出　　处：《临床和实验医学杂志》2024年第24期2616-2620,共5页Journal of Clinical and Experimental Medicine

基　　金：2022年度湖北省自然科学基金项目(编号:20220709117)。

摘　　要：目的研究前后入路联合手术对脊髓型颈椎病(CSM)患者脊髓功能恢复的影响。方法回顾性纳入2022年2月至2024年2月在湖北省中西医结合医院择期手术治疗的120例CSM患者,根据术式不同分为前入路手术组(n=40)、后入路手术组(n=40)和联合手术组(n=40)。前入路手术组给予前入路颈椎间盘切除融合内固定(ACDF),后入路手术组给予后入路椎板切除椎弓根内固定(PLF),联合手术组给予前后入路联合手术结合ACDF术与PLF术。比较3组患者的手术指标(手术时间、手术出血量、首次离床时间、住院时间),手术前与手术后3个月的脊髓功能[日本骨科协会(JOA)评分]、颈椎恢复情况[颈椎前凸角(Cobb角)与颈椎活动度(ROM)]以及并发症发生情况。结果联合手术组患者的手术时间、手术出血量、首次离床时间、住院时间分别为(139.64±13.72)min、(317.77±34.52)mL、(5.62±0.61)d、(23.78±4.19)d,均明显高于前入路手术组[(80.41±9.22)min、(116.45±21.38)mL、(2.31±0.28)d、(13.42±1.69)d]及后入路手术组[(112.19±11.48)min、(248.96±26.92)mL、(4.11±0.45)d、(19.75±2.54)d],差异均有统计学意义(P<0.05);后入路手术组患者的手术时间、手术出血量、首次离床时间、住院时间均明显高于前入路手术组,差异均有统计学意义(P<0.05)。手术后3个月,3组患者的JOA评分均较术前明显增高,且联合手术组患者术后JOA评分为(13.42±1.61)分,明显高于前入路手术组[(8.92±1.04)分]与后入路手术组[(8.75±1.11)分],差异均有统计学意义(P<0.05);前入路手术组与后入路手术组术后JOA评分比较,差异无统计学意义(P>0.05)。手术后3个月,3组患者的Cobb角均明显大于手术前,ROM均明显小于手术前,差异均有统计学意义(P<0.05);联合手术组患者术后Cobb角为(8.74±0.84)°,明显大于前入路手术组[(6.67±0.79)°]与后入路手术组[(6.52±0.65)°],ROM为(40.08±3.162)°,明显大于前入路手术组[(31.25±3.12Objective To study the effect of anterior-posterior combined surgery on spinal functional recovery in patients with cervical spondylotic myelopathy(CSM).Methods The 120 CSM patients treated by elective surgery in Hubei Hospital of Integrated Traditional Chinese and Western Medicine from February 2022 to February 2024 were prospectively divided into anterior surgery group(n=40),posterior surgery group(n=40)and combined surgery group(n=40)according to different operation methods.Anterior cervical discectomy and fusion(ACDF)was performed in the anterior surgery group,posterior lumbar-fusion(PLF)was performed in the posterior surgery group,anterior and posterior approach combined surgery combined with ACDF and PLF was performed in the combined surgery group.The operation indexes(operation time,bleeding volume,first time out of bed,hospitalization time),spinal cord function[Japanese Orthopaedic Association score(JOA)],cervical spine recovery[cervical lordosis angle(Cobb angle)and range of motion(ROM)]before and 3 months after operation and complications were compared among the three groups.Results The operation time,blood loss,first time out of bed and hospitalization time in the combined surgery group were(139.64±13.72)min,(317.77±34.52)mL,(5.62±0.61)d and(23.78±4.19)d,respectively,which were significantly higher than those in the anterior surgery group[(80.41±9.22)min,(116.45±21.38)mL,(2.31±0.28)d,(13.42±1.69)d]and the posterior surgery group[(112.19±11.48)min,(248.96±26.92)mL,(4.11±0.45)d,(19.75±2.54)d],the differences were statistically significant(P<0.05).The operation time,bleeding volume,first time out of bed time and hospitalization time in the posterior surgery group were significantly higher than those in the anterior surgery group,and the differences were statistically significant(P<0.05).At three months after operation,the JOA scores of the three groups were significantly higher than those before operation,and the JOA score of the combined surgery group was(13.42±1.61)points,which was signific

关 键 词：颈椎 脊髓型颈椎病 前后入路联合手术 脊髓功能 

分 类 号：R68[医药卫生—骨科学]