多节段脊髓型颈椎病经后路的不同手术方式

目的：比较全椎板切除减压、椎管扩大成形与棘突重建颈椎管扩大成形等手术方式治疗多节段脊髓型颈椎病的治疗效果。方法：116例中采用全椎板切除减压术（A组）37例,单开门椎管扩大成形术（B组）49例,单开门棘突重建颈椎管扩大成形术（C组）30例;根据JOA评分、颈部轴性症状及X线表现比较平均改善率。结果：经3～36个月,平均18个月随访,各组术后3个月和12个月与术前评分比较有显著性差异（P〈0.05）,各组间比较无显著性差异（P〉0.05）;12个月改善率,A组比B、C两组较术后3个月时有显著下降（P〈0.05）。结论：3种手术方法均可获得满意的效果,全椎板切除减压术的神经功能改善率低,疗效维持时间短,颈部轴性症状及颈椎后突畸形等并发症发生率高。

Different Posterior Approaches for Multi-segment Cervical Myelopathy

Objective To compare the clinical effects of different procedures for multi-segment cervical myelopathy. Methods There were 116 patients with multi-segment cervical myelopathy.Thirty-seven patients were treated by complete laminectomy operation （A group）;49 patients were treated by unilateral expansive laminoplasty of cervical vertebra （B group）;and 30 patients were treated by unilateral expansive laminoplasty of cervical vertebra with reconstruction of spinous processes （C group）.The clinical effects were appraised by JOA criteria,cervical axial symptoms and X-ray demonstrations. Results All 116 cases were followed for 3 to 36 months,averaged 18 months.After 3 months and 12 months of operation,the clinical effects were significantly different from that before operation in the three groups （P〈0.05）.There were no significant differences among the three groups,（P〉0.05）,but the clinical effect was the lowest significantly in A group than that in B group and C group after 3 months of operation （P〈0.05）. Conclusion The clinical effects were satisfactory in these three groups.But the lowest improvement rate of nervous function,shortest duration of clinical effect and highest complication of cervical axial symptoms and kyphosis and distortion of the spinal column were found in A group.