显微镜辅助下颈前路精细化减压治疗脊髓型颈椎病的临床研究

目的 探讨显微镜下颈前路精细化减压治疗脊髓型颈椎病的疗效。方法 回顾性分析2016年1月—2017年5月中国科学技术大学附属第一医院脊柱外科行颈前路手术的70例脊髓型颈椎病患者的临床资料。其中男37例、女33例,年龄38~86(58.2±7.4)岁。根据手术方式分为两组,其中显微组35例行显微镜下减压内固定术,开放组35例行常规开放前路减压内固定术。比较两组患者的手术时间、术中出血量、术后引流量、引流管留置时间以及术后并发症发生情况,在术后1、3、6个月及1年比较两组患者的日本骨科学会(JOA)评分及其改善率,颈椎功能障碍指数评分以评价术后神经功能改善情况。结果 显微组和开放组的手术时间、术中出血量、术后引流量、引流管留置时间分别为(75.13±11.06)min、(26.14±16.36)mL、(26.42±15.37)mL、(1.09±0.60)d和(74.86±10.57)min、(45.36±18.05)mL、(51.23±16.42)mL、(1.11±0.58)d,显微组的术中出血量、术后引流量均低于开放组,差异均有统计学意义(P值均＜0.01)。显微组术后1、3、6个月的神经功能JOA评分高于开放组,差异均有统计学意义(P值均＜0.01),但在术前及术后1年差异均无统计学意义(P值均＞0.05)。术后1、3个月显微组神经功能改善率高于开放组(P值均＜0.01),而术后6个月、1年时组间差异均无统计学意义(P值均＞0.05)。显微组术后1、3个月颈椎功能障碍指数评分均低于开放组,差异均有统计学意义(P值均＜0.01);但在术前、术后6个月及术后1年组间比较,差异均无统计学意义(P值均＞0.05)。结论 脊髓型颈椎病患者显微镜辅助下颈前路减压手术相比于传统颈前路开放手术,具有减压精准、创伤小、出血少、疼痛轻、术后恢复快等优势,能显著改善患者术后的神经功能,提高生活质量,疗效确切,值得国内脊柱外科医师在临床推广和应用。

Clinical research of elaborative decompression under microscope through anterior cervical approach in the treatment of cervical spondylotic myelopathy

Objective To discuss the effect of elaborative decompression under microscope through anterior cervical approach in the treatment of cervical spondylotic myelopathy. Methods Clinical data of 70 cases of cervical spondylotic myelopathy in our hospital from January 2016 to May 2017 were retrospectively analysis. They were divided into microscopical group and open group. There were 35 patients with elaborative decompression under microscope through anterior cervical approach, 35 patients with traditional open cervical anterior decompression.The operative time, intraoperative blood loss, postoperative drainage volume, drainage tube retention time, hospital stay and postoperative complications between the two groups were compared. Before and after 1 month, 3 months, 6 months, 1 year points, the Japanese Orthopaedic Association (JOA) score, improvement rate and cervical disability index score were used to evaluate postoperative neurological function improvement. Results The operative time, intraoperative blood loss, intraoperative blood transfusion volume, postoperative drainage volume, drainage tube retention time, hospital stay in microscopical group were (75.13±11.06)min, (26.14±16.36)mL, (26.42±15.37)mL, (1.09±0.60)d and the operative time, intraoperative blood loss, intraoperative blood transfusion volume, postoperative drainage volume, drainage tube retention time in open group were (74.86±10.57)min, (45.36±18.05)mL, (51.23±16.42)mL, (1.11±0.58)d. The intraoperative blood loss, postoperative drainage volume, in microscopical group were lower than those in open group, and the differences were statistically significant (all P values＜0.01). The JOA score at 1 month, 3 months, 6 months after operation in microscopical group were higher than those in open group, and the differences were statistically significant (all P values＜0.01). There were no significant differences in JOA score before operation and 1 year after operation time points between the two groups (all P values＞0.05). The JOA score's improvement rate at 1 month and 3 months after operation in microscopical group were higher than those in open group(all P values＜0.01), but there were no significant differences at 6 months and 1 year after operation between the two groups(all P values＞0.05). The cervical disability index score at 1 month, 3 months, after operation in microscopical group were higher than those in open group, and the differences were statistically significant (all P values＜0.01). There were no significant differences in cervical disability index score before operation and 6 months, 1 year after operation points between the two groups (all P values＞0.05). Conclusions Compared with traditional open cervical anterior decompression, elaborative decompression under microscope through anterior cervical approach has the advantages of accurate decompression, less trauma, less bleeding, less pain and quick recovery after operation. It can significantly improve the postoperative neurological function, improve the quality of life, the curative effect is accurate. It worthy to be popularized and applied by domestic spinal surgeons in anterior approach surgery.