单纯前路或后路手术治疗多节段颈椎病的疗效观察

目的]评价采用单纯颈椎前路或后路治疗多节段颈椎病的临床疗效及对颈椎生理曲度的影响。方法]2005年1月至2013年1月期间采用颈椎前路或后路治疗多节段颈椎病患者32例。前路组16例：其中选择性椎体次全切除联合椎间盘切除（ACHDF）8例；2椎体次全切钛网植骨钛板内固定（ACCF）4例；单椎体次全切结合相邻节段人工椎间盘置换（Hybrid）4例。后路组16例：后路单开门椎管成形术（laminoplasty ）8例；椎板切除植骨内固定术（LIFF）8例。记录手术并发症情况，比较前后入路下患者术前和术后随访时疼痛视觉模拟评分（VAS）﹑日本骨科协会（JOA）评分。侧位X线观察颈椎生理曲度恢复情况。结果]手术均顺利完成，术后随访平均18（7～26）个月。前路和后路组患者颈部 VAS评分、上肢 VAS评分、JOA 评分术后较术前均明显改善（均 P ＜0．05），但术前术后两组间比较差异没有统计学意义（ P ＞0．05）。随访期间影像学检查内置物位置正确，植骨均在3～6全月内融合。前路及后路两组颈椎曲度术后较术前均有不同程度恢复（ P ＜0．05）；末次随访颈椎曲度比较差异无统计学意义（ P ＞0．05）。结论]个体化设计合适的手术方式，前后路术式均能有效解除神经压迫，恢复颈椎生理曲度，但前路较后路在降低手术时间和减少术中出血上具有一定优势。

Observation of the Efficacy of Simple Anterior or Posterior Operation for the Treatment of Multi-level Cervical Spondylosis

Objective] To evaluate the clinical efficacy of cervical anterior or posterior operation for the treat-ment of multilevel cervical spondylosis and its influence on cervical curvature .Methods] A total of 32 patients （aged 36~67 years of average 55 years ,19 males and 13 females） with multilevel cervical spondylosis underwent the operation via anterior or posterior approach from Jan .2005 to Jan .2013 .In anterior group（n=16） ,8 patients underwent selective anterior cervical hybrid decompression and fusion （ACHDF） ,and 4 patients underwent anteri-or cervical corpectomy and fusion（ACCF） on two segments ,and 4 patients underwent artificial cervical disc arthro-plasty combined with adjacent segment fusion（Hybrid） .In posterior group（ n=16） ,8 patients underwent lamin-oplasty and 8 patients underwent laminectomy with internal fixation and fusion （LIFF） .Surgical complications were recorded .Visual analogue scale（VAS） and Japanese orthopedic association（JOA） score during preoperative and postoperative follow-up were compared between anterior and posterior approach patients .Cervical curvature was observed by lateral X-ray .Results]Compared with before operation ,neck and upper limb VAS and JOA score in anterior group and posterior group after operation were obviously improved （all P 〈0 .05） ,but there was no significant difference between two groups before and after operation （ P 〉0 .05 ） .During the follow-up ,the image examination showed that the location of implants were right and bone fusion was obtained within 3 ~ 6 months .Compared with before operation ,cervical curvature had different levels of recovery in two groups after operation （ P 〈0 .05） .Cervical curvature of 14 patients in anterior group and 13 patients in posterior group were normal at final follow-up ,but there was no significant difference between two groups （ P 〉 0 .05） .Conclusion]Individualized appropriate surgical methods should be planned .Both anterior and posterior operation can effectively relieve nerve compression and recover cervical curvature so as to get a good clinical efficacy .Compared with poste-rior operation ,the anterior operation has certain advantages in reducing the operative time and intraoperative bleed-ing .