摘要
目的:评价颈椎前路分节段减压植骨内固定术和长节段减压植骨内固定术两种手术方法治疗多节段脊髓型颈椎病的临床疗效。方法:选择51例连续三节段及以上病变的多节段脊髓型颈椎病患者,采取随机分组方式分为两组,其中22例采取长节段减压植骨内固定术(A组);29例采取分节段单个椎体次全切除植骨内固定+其他椎间盘单独切除内固定术(B组),即分节段减压植骨内固定术。比较两组手术时间、术中出血量、住院时间,两组患者分别在术前、术后3 d、3个月、6个月、12个月应用JOA评分评价神经功能改善率,复查X片比较两组植骨融合率、颈椎椎间高度、颈椎生理弧度恢复情况。结果:A组手术时间、术中出血量、住院时间均高于B组,差异有统计学意义(P<0.05);JOA评分结果显示两组术后各时间点评分较术前均有明显提高(P<0.01),组间术后各时间点间比较无显著性差异(P>0.05);两组随访内固定均未发生松动、脱落、断裂,Cobb角均较术前改善(P<0.05),但术后随访角度丢失率A组高于B组(P<0.05)。A组有1例术后1年出现钛网下沉。两组植骨融合率于术后6个月时均为100%,但B组至术后3个月已达骨性融合,A组有4例至术后6个月时达骨性融合。结论:两种手术方法治疗多节段脊髓型颈椎病均可获得满意的临床疗效;但颈椎前路分节段减压植骨内固定术相对术中出血少、手术时间短、创伤小、颈椎前中柱结构破坏少,同时能够长时间维持颈椎曲度和椎间高度,是一种较好的手术方式。
Objective：To evaluate the clinical effects of two surgical techniques to the treatment of multi-segmental cervical spondylotic myelopathy. Methods：Fifty-one patients of multilevel cervical myeopahty with consecutive 3 segment lesions or more were included and randomly allocated to two groups by treating with either long segment decompression and fixation with bone grafting （Group A,n=22） or single sub-segments corpectomy and inter-nal fixation combined with additional single subtotal resection of vertebral body and fusion of internal fixation（Group B,n =29）.Two groups were com-pared regarding the operative time,intraoperative blood loss,length of hospital stay,scoring by Japanese Orthopaedic Association（JOA） and improvement of neurological function at the 3 rd day,by 3 rd,6 th and 12 th month before and after the procedure,respectively.X-ray was performed to examine the fu-sion condition of bone grafting,height of intervertebral space and cervical curvature.Results：The operative time,intraoperative blood loss,length of hospital stay was generally greater in Group A than Group B,which had statistical significance（P〈0.05）.JOA scoring showed significant improvement by different time phase for the two groups compared with pre-operation,yet suggested no significant difference pertinent to corresponding time phase between the two groups（P＆gt;0.05）.Follow-up revealed no loosening,dislocation and breakage of the internal fixation and showed improvement of Cobb′s angle after opera-tion（P〈0.05）,yet Group A had a larger loss of the angle rate than that of Group B（P〈0.05）.Subsided titanium mesh occurred in 1 case in Group A one year after surgery.Although the fusion rate of bone grafting were 100% for the two groups by the 6th month,whereas the postoperative fusion occurred by the 3 rd month for Group B and 4 th to 6 th month in Group A .Conclusion：Both surgical modalities can lead to satisfactory clinical efficacy for multi-segmental cervical spondylotic myelopathy,yet segmental anterior cervical decompression plus internal fixation with bone grafting appears recommendable , for it tends to result in relatively minor intraoperative blood loss,shortened operative time,minor surgical trauma,less destruction to the anterior cervical column structure and long-term maintenance of the cervical curvature and height of intervertebral space.
出处
《皖南医学院学报》
CAS
2014年第1期32-35,39,共5页
Journal of Wannan Medical College
基金
卫生部公益性行业专项基金项目(201002018)
关键词
脊髓型颈椎病
前路手术
融合
cervical spondylotic myelopathy
anterior surgery
fusion
