脊髓型颈椎病前后路手术的选择

目的：探讨脊髓型颈椎病前后路手术的适应证并评定其疗效。方法：自2002年6月至2006年6月采用前后路治疗125例脊髓型颈椎病患者，男71例，女54例；年龄28-69岁，平均53．4岁。病程0．5-48个月，平均14个月。58例行前入路，67例行后入路。通过JOA评分系统对手术前后神经功能分析，总结颈椎前后路手术疗效。结果：所有患者均获得随访，时间6-30个月，平均18个月。按JOA评分标准：颈前路手术组术前（8．78±2．43）分，术后（14．68±2．37）分，其中优40例，良10例，有效6例；颈后路手术组术前（8．49±2．58）分，术后（14．26±2．83）分，其中优42例，良12例，有效8例。6例手术无效，其中前路2例，后路4例，后路1例术后症状加重。两组间疗效无统计学差异（P〉0．05），但同一入路术前术后比较有统计学差异（P〈0．05）。结论：前后路手术均能对脊髓型颈椎病的治疗起到良好的作用，来自前方的压迫，少节段病变，以锥体束受压症状为主者，原则上采取前路手术；而对于来自脊髓后方的压迫，多节段病变，以感觉障碍为主、伴有颈椎椎管狭窄者，则以颈后路手术为主。

Alternatives of anterior and posterior approaches for cervical spondylotic myelopathy

Objective: To discuss on the effect of cervical spondylotic myelopathy before and after surgery and assess its indications and efficacy. Methods: From June 2002 to June 2006,125 patients with cervical spondylotic myelopathy were analyzed retrospectively involving 58 anterior routine and 67 posterior routine,of which 71 cases of males,54 cases of females,aged from 28 to 69 years(average 53.4 years). The course was 0.5 to 48 months(means 14 months). According to JOA score system preoperative and postoperative nerve function were analyzed,summarized anterior and posterior cervical spine surgery. Results: All patients were followed up for from 6 to 30 months(average of 18 months). According to JOA score criteria: anterior cervical surgery preoperative JOA score was(8.78 ± 2.43) points,postoperative JOA score was(14.68 ± 2.37) points,the results were excellent in 40 cases,good in 10 cases,effective in 6. Posterior surgical group preoperative JOA score was(8.49 ± 2.58) points, postoperative JOA score was(14.26 ± 2.83) points,the results were excellent in 42 cases,good in 12 cases,effective in 8. Invalid operation occurrenced in 6 cases included 2 of anterior,4 of posterior. The postoperative symptoms had worsed in 1 case of posterior operation. The two groups had no statistical difference in efficacy,but there were differences statistically in the same approach comparing preoperative and postoperative. Conclusion: Both anterior and posterior approaches have fine effect to the treatment of cervical spondylotic myelopathy(CSM). But the selection of the indication is very important,the patients with the pressure from anterior,the short-level changes,and the main symptoms of pyramid trac compression,adopt anterior approach on principle. While the patients with the pressure of spinal cord from posterior,multilevel changes,main symptoms of sensory disturbances,and accompanied by cervical spine canal stenosis mainly is introduced posterior approach.