颈椎前路椎间盘切除融合术和后路单开门椎板成形术治疗多节段脊髓型颈椎病的早期并发症对比

目的对比颈椎前路椎间盘切除融合术(ACDF)和后路单开门椎板成形术治疗多节段脊髓型颈椎病(CSM)的早期并发症。方法 2010年1月—2014年12月收治多节段CSM患者236例,111例采用ACDF治疗(前路组)、125例采用颈椎后路单开门椎板成形术治疗(后路组)。记录患者术前和末次随访时颈椎曲度、日本骨科学会(JOA)评分以及术后3个月内并发症发生情况。结果末次随访时前路组颈椎曲度(14.8°±4.1°)优于后路组(9.5°±2.8°),差异有统计学意义(P 0.05);前路组末次随访时JOA评分和JOA评分改善率(14.6±1.2)分、(75.6±3.5)%]均优于后路组(13.2±2.0)分、(62.7±5.6)%],差异均有统计学意义(P 0.05)。14例患者术后早期发生并发症,发生率为5.93%,其中前路组5例(4.50%,5/111),后路组9例(7.20%,9/125)。最常见的并发症为喉上/喉返神经损伤(5例,前路组),最严重的并发症为脊髓损伤(3例,后路组),其余为C5神经根麻痹(2例)、脑脊液漏(2例)、切口愈合不良(1例)、切口血肿(1例),均为后路组病例。无食管、气管瘘及死亡患者。结论 ACDF和后路单开门椎板成形术治疗多节段CSM均可获得满意的临床疗效,ACDF能获得更好的颈椎曲度和神经功能,且并发症发生率较低。

Comparison of early complications between anterior cervical discectomy and fusion and posterior single open-door laminoplasty for multilevel cervical spondylotic myelopathy

Objective To compare the early complications of anterior cervical discectomy and fusion(ACDF) and posterior single open-door laminoplasty in the treatment of multilevel cervical spondylotic myelopathy(CSM). Methods A total of 236 patients with multilevel CSM were treated from January 2010 to December 2014,111 by ACDF(anterior group),125 by posterior single open-door laminoplasty(posterior group). Preoperative and final follow-up cervical curvature,Japanese Orthopaedic Association(JOA) score and incidence of complications within 3 months after operation were recorded. Results At the final follow-up,the cervical curvature of anterior group(14.8°±4.1°) was better than that of posterior group(9.5°±2.8°),and the difference was statistically significant(P<0.05). The JOA score and improvement rate of JOA in the anterior group(14.6±1.2)and (75.6±3.5)%] were superior to those in the posterior group(13.2±2.0) and (62.7±5.6)%],and the differences were statistically significant(P<0.05). A total of 14 patients had early postoperative complications,and the incidence rate was 5.93%,including 5 in the anterior group(4.50%,5/111) and 9 in the posterior group(7.20%,9/125). The most common complication was the superior/recurrent laryngeal nerve injury(5 cases,anterior group);the most serious complication was the spinal cord injury(3 cases,posterior group). There were 2 cases of C₅ nerve root paralysis,2 of corebrospinal fluid leakage,1 of poor wound healing and 1 of incisional hematoma,all of whom were in posterior group. There was no esophageal fistula,tracheal fistula and death. Conclusion Both ACDF and posterior single open-door laminoplasty have good clinical effect in treatment of multilevel CSM. ACDF can obtain better cervical curvature and nerve function,and the incidence rate of complications is low.