前路联合术式与后路单开门治疗3节段脊髓型颈椎病的疗效观察

目的:比较前路颈椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)联合前路椎体次全切钛网植骨融合术(anterior cervical corpectomy and fusion,ACCF)与颈后路单开门微型钛板内固定术治疗3节段脊髓型颈椎病的临床疗效。方法:对2014年3月至2016年3月手术治疗的63例(男39例,女24例)3节段脊髓型颈椎病患者的临床资料进行回顾性分析,其中43例行ACDF联合ACCF(前路组),20例行颈后路单开门微型钛板内固定术(后路组)。比较两组患者的手术时间、术中出血量、术后并发症发生率,并按照JOA评分标准评定两组患者的临床疗效。结果:所有病例获得随访,时间16~40个月,平均25.8个月。前路组与后路组患者手术时间分别为(123.70±6.21)min和(118.70±5.41)min,差异无统计学意义(P0.05);术中出血量分别(85.23±7.51)ml和(107.18±9.41)ml,差异有统计学意义(P0.05)。前路组发生轴性症状6例,吞咽困难1例,未发生C5神经根麻痹、声音嘶哑及呛咳等并发症,并发症发生率为16.3℅(7/43);后路组发生轴性症状5例,C5神经根麻痹1例,未发生吞咽困难、声音嘶哑及呛咳等并发症,并发症发生率为30.0℅(6/20),两组并发症发生率比较差异有统计学意义(P0.05)。前路组术后1周及末次随访时的JOA评分均优于后路组(P0.05)。结论 :两种手术方式治疗脊髓型颈椎病均能提供即刻的稳定性,前路联合手术在术中出血量、并发症发生率、临床疗效方面均优于后路组,因此对于连续性3节段脊髓型颈椎病的治疗倾向于前路联合手术。

Comparison of clinical effects between anterior cervical discectomy combined with corpectomy and cervical posterior single open-door laminoplasty in treating three-segment cervical spondylotic myelopathy

Objective:To compare the clinical effects between anterior cervical discectomy and fusion(ACDF) combined with anterior cervical corpectomy and fusion(ACCF) and cervical posterior single open-door laminoplasty with mini-titanium plate fixation in treating three-segment cervical spondylotic myelopathy.Methods:The clinical data of 63 patients (39 males and 24 females) with three-segment cervical spondylotic myelopathy underwent surgical treatment from March 2014 to March 2016 were retrospectively analyzed. Among them,43 cases were treated by ACDF combined with ACCF(anterior group),and 20 cases were treated by cervical posterior single open-door laminoplasty with mini-titanium plate fixation(posterior group). Operative time,intraoperative blood loss,postoperative complications were compared between two groups. And according to JOA score to evaluate the clinical effect.Results:All the patients were follow-up from 16 to 40 months with an average of 25.8 months. Operative time of anterior group and posterior group were (123.70±6.21) min and(118.70±5.41) min,respectively,there was no significant difference between two groups(P>0.05). Intraoperative blood loss of anterior group and posterior group were (85.23±7.51) ml and (107.18±9.41) ml,respectively,there was significant difference between two groups(P<0.05). In anterior group,axial symptoms occurred in 6 cases,dysphagia in 1 case,and no C₅ nerve root palsy,hoarseness and choking cough were found,the incidence rate of complication was 16.3%(7/43);and in posterior group,axial symptoms occurred in 5 cases,C₅ nerve root palsy in 1 case,and no dysphagia,hoarseness and choking cough were found,the incidence rate of complication was 30.0%(6/20);there was significant defference in incidence rate of complication between two group(P<0.05). At 1 week after operation and final follow-up,the JOA scores of anterior group were obviously better than that of posterior group(P<0.05).Conclusion:Above-mintioned two surgical treatment for cervical spondylotic myelopathy can provide instantly stability,the method of ACDF combined with ACCF was obviously better that of the method of cervical posterior single open-door laminoplasty in intraoperative blood loss,the incidence rate of complications,clinical effect.Thus,for the treatment of three-segment cervical spondylotic myelopathy,the method of ACDF combined with ACCF would be firstly chosen