多节段颈椎间盘突出症的前后路手术疗效比较

目的　比较多节段颈椎间盘突出症颈椎前后路手术疗效。　方法　回顾性总结 1999年以来治疗的 5 6例多节段颈椎间盘突出症病例 ,其中前路手术组 37例 ,采用摘除病变椎间盘、选择性椎体次全切除、植骨融合及前路钢板固定 ;后路手术组 19例 ,采用全椎板减压、侧块钢板固定。　结果　前路手术者术后随访 6个月～ 4年 5个月 ,平均 2年 10个月 ;后路手术者随访 1年 5个月～ 5年 1个月 ,平均 3年 8个月。两组 JOA评分及硬脊膜囊矢状径比较术前差异无统计学意义 (P>0 .0 5 ) ,术后差异有统计学意义 (P<0 .0 1) ,前路手术组高于后路手术组 ;术后改善率前路手术组高于后路手术组 ,差异有统计学意义 (P<0 .0 1) ;并发症例数前路手术组略多于后路手术组。　结论　前路手术组疗效明显优于后路手术组。前路减压、植骨、钢板固定术是治疗多节段颈椎间盘突出症的有效方法

COMPARISON STUDY ON THERAPEUTIC EFFECTS OF ANTERIOR APPROACH VERSUS POSTERIOR APPROACH IN TREATING MULTILEVEL CERVICAL DISC HERNIATION

Objective To investigate the therapeutic effects of anterior approach set (AAS) versus posterior approach set (PAS) in treating multilevel cervical disc herniation of three or four segments. Methods Fifty-six cases of multilevel cervical disc herniation were retrospectively studied. Thirty-seven cases underwent anterior approach, and discectomy, selectively partial corpectomy with bone grafting and plate fixing was performed (AAS group); 19 cases underwent posterior approach, and laminectomy with lateral cervical mass plate screw fixing was performed (PAS group).Results The follow-up periods were 6 months to 4 years and 5 months, averaging 2 years and 10 months in AAS group and 1 year and 5 months to 5 years and 1 month, averaging 3 years and 8 months in PAS group. JOA functional assessment and sagittal diameter of dural sac were not statistically significant between two groups before operation (P>0.05) and were significantly larger in AAS group than in PAS group after operation (P<0.01). The improvement rate of AAS was significant higher than that of PAS (P<0.01). The number of complication in AAS were slight more than that in PAS.Conclusion AAS is obviously better than PAS in the therapeutic effects. The operation of anterior decompression with bone grafting and plate fixing is an indication of multilevel cervical disc herniation of three or four segments.