36例多节段脊髓型颈椎病前后路术式的疗效分析

目的 分析和比较前后路术式治疗多节段脊髓型颈椎病的效果。方法 对36例多节段脊髓型颈椎病患者分别采用颈前路2个（或2个以上）椎体次全切除脊髓减压、钛网植骨支撑融合内固定术（21例）及颈后路脊髓受压段全椎板切除减压、植骨加侧块螺钉内固定术（15例）治疗，术后根据JOA评分及X线表现比较两组病例的改善率、植骨融合率及颈椎生理曲度恢复情况。结果 平均随访12个月，前路手术组平均改善率70％，优良率为81％，后路手术组平均改善率62％，优良率78％，两组疗效差异无显著性意义（P〉0．05），前路手术组1例植骨未融合，植骨融合率95％，后路手术组3例植骨未融合，植骨融合率80％，两组颈椎生理曲度均有不同程度恢复。结论 两种术式疗效相近，但前路多个椎体次全切除脊髓减压、钛网植骨支撑融合内固定术植骨融合率高、术时短、出血少，较之后路术式更安全有效。

Therapeutic Effectiveness of Multilevel Cervical Spondylotic Myelopathy Treated by Anterior and Posterior operative Approaches

Objective To analyze and compare the therapeutic effectiveness of anterior and posterior operative approaches in the treatment of multi-segment cervical spondylotic myelopathy.Methods Among 36 cases of multi-segment cervical spondylotic myelopathy,21 cases were subjected to two and/or over two vertebral body deutero-total resection for spinal decompression,titanium net bone graft pedestal to fuse internal fixation of anterior approach,and the remaining 15 cases to whole laminectomy for decompression,bone graft plus lateral mass bolt internal fixation of posterior approach of the spinal cord decompression section.Symptom improvement rate,bone graft fusion rate and recovery of cervical vertebra physiological camber were compared according to JOA standard and X-ray appearance after surgery.Results The average follow-up period was 12 months.Average symptom improvement rate,fineness rate in anterior approach group and posterior approach group was 70% and 81%,and 62% and 78% respectively with the difference being not significant(P>0.05).In anterior approach group and posterior approach group,the bone graft fusion rate was 95% and 80% respectively.Cervical vertebra physiological camber in two groups was restored to some extent.Conclusion Both procedures had similar therapeutic effectiveness,but via anterior approach,bone graft fusion rate was higher,operating time was shorter and blood loss was less than those via posterior approach.