摘要
目的通过对比性研究,评价前路长节段减压法及分段减压法治疗多节段受累的脊髓型颈椎病(cervicalspondyloticmyelopathy,CSM)的疗效。方法回顾性分析1999年7月~2004年1月,采用前路长节段减压法19例和分段减压法33例治疗并获随访的多节段受累的CSM患者资料,根据随访X线片及MRI评估围手术期并发症的发生率、植骨融合率,根据JOA评分评估神经功能改善率。结果长节段减压组围手术期并发症的发生率为36.8%,包括内固定及植骨块松动移位,经翻修手术治愈;分段减压组围手术期并发症的发生率为12.1%,包括钛网下沉及植骨螺钉松动,经延长外固定时间治愈;两组间比较差异有统计学意义(P<0.05)。两组患者经9~31个月随访,平均11.2个月。长节段减压组和分段减压组的植骨融合率分别为84.2%和81.8%,术后JOA评分平均改善率分别为64.4%和70.4%;两组间差异均无统计学意义(P>0.05)。结论分段减压法治疗多节段受累的CSM更趋合理,其减压效果与长节段减压法相似,优势在于更利于脊柱稳定性的即刻重建及长期保持,为植骨融合提供稳定的局部力学环境。
Objective To compare the outcomes of two operative methods, the anterior decompression in subsection and the anterior decompression in one section, which were used to treat multilevel cervical spondylotic myelopathy （CSM）. Methods Data of multilevel CSM undergoing the anterior decompression in subsection （33 cases, the subsection group） and the anterior decompression in one section （19 cases, the one section group） from July 1999 to January 2004 were retrospectively analyzed. The incidence of perioperative complications and the rate of fusion were evaluated by the postoperative X-ray and MRI examinations, and improvement of the neurological function was evaluated by the JOA score. Results The incidence of perioperative complications was 36.8% in the one section group, mainly including immigration of the plate and grafts, which was settled by the revision surgery; while the incidence of perioperative complications was 12.1% in the subsection group, mainly including the immigration of the titanium mesh. There was a significant difference between the two groups （P〈0.05）. 84.2% of the patients in the one section group and 81.8% of the patients in the subsection group developed bony fusion by the end of the follow-up （9-31 mon, averaged 11.2 mon）, and there was no significant difference between the two groups （P^0. 05）. According to the JOA score, the ratio of the improvement in the neurological function was 70.4% in the subsection group and 64.4% in the one section group. There was no significant difference between the two groups （P〉0. 05）. Conclusion The anterior decompression in subsection is more rational for the surgical treatment on the multilevel CSM than the anterior decompression in one section. It can provide an equal decompressive effect but a more stable local mechanical environment right after the surgery and can maintain it well, which is critical for the honv fusion.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2006年第4期362-366,共5页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
脊髓型颈椎病
多节段
内固定
前路手术
比较
Cervical spondylotic myelopathy Multilevel Internal fixation Anterior surgery Comparison
