合并颈椎病的腰椎管狭窄症的两种手术方法的疗效比较

目的探讨合并颈椎病的腰椎管狭窄症手术方法的选择及疗效。方法2004年3月至2006年5月，共治疗56例合并颈椎病的腰椎管狭窄症患者，男32例，女24例，平均年龄59岁。A组24例仅行腰椎手术；B组32例在一次麻醉下对颈椎和腰椎进行一期手术，观察所有病例手术前、后及最后随访时的颈、腰椎JOA评分，分析手术并发症，以评价手术疗效。结果平均随访38个月，A组平均手术时间2．1h，出血量350ml，术后有4例需行颈椎二期手术。术前、术后及最后随访时的腰椎JOA评分分别为6．3±2．2，11．8±1．4和11．3±1．8，优良率为79．2％，而颈椎JOA评分较术前下降。B组平均手术时间5．2h，出血量1100ml，术前、术后及最后随访时的颈椎JOA评分分别为7．5±2．1，12．9±1．6和12．1±1．4，腰椎JOA评分分别为6．7±2．5，12．8±1．3和12．1±1．6，优良率为87．5％。结论术前全面评估患者的临床症状，选择合适的手术方法，合并颈椎病的腰椎管狭窄症的治疗可取得较好的临床效果。

The surgical treatment of lumbar spinal stenosis with cervical spondylotic myelopathy

Objective To explore the surgical options and outcomes of lumbar spinal stenosis with cervical spondylotic myelopathy. Methods Fifty-six patients of coexisting lumbar spinal stenosis and cervical spondylotic myelopathy were treated between March 2004 and May 2006. There were 32 males and 24 females with the mean age of 59. In group A, 24 cases were treated by posterior lumbar spinal decompression with or without instrumentation. In group B, 32 cases were treated by simultaneous surgery for the cervical and lumbar spine. All cases were followed up and graded with JOA score system pre-op, post-op and during the follow-up. The complications and clinical outcomes were analyzed. Results The average follow-up time was 38 months. In group A, the mean operation time was 2.1 hours, and the mean blood loss was 350ml. Four cases （16.7%） needed re-operation during the follow-up because Of the exacerbation of cervical spondylotic myelopathy. The average lumbar JOA score of pre-op, post-op and the last follow-up were 6.3±2.2, 11.8±1.4 and 11.3±1.8, respectively. The satisfaction rate of the clinical results was 79.2%. But the average cervical JOA score of post-op was lower than pre-op （P〈0.05）. In group B, the mean operation time was 5.2 hours, and the mean blood loss was 1100ml. The average cervical JOA score of pre-op, post-op and the last follow-up were 7.5±2.1, 12.9±1.6 and 12.1±1.4, respectively. The average lumbar JOA score of pre-op, post-op and the final follow-up were 6.7±2.5, 12.8±1.3 and 12.1±1.6, respectively. The satisfaction rate of the clinical results was 87.5%. Conclusions The clinical results are satisfactory in patients with lumbar spinal stenosis and cervical spondylotic myelopathy, but the patient＇s clinical symptoms must be evaluated thoroughly before operation and the selection of appropriate surgical methods.