不同手术方案对脊髓型颈椎病合并椎管狭窄症患者术后疗效及颈椎矢状位参数的影响

目的探讨前路椎体次全切除术和后路椎管扩大椎板成形术对脊髓型颈椎病(CSM)合并椎管狭窄症患者术后疗效及颈椎矢状位参数的影响。方法回顾性分析2010年3月-2015年8月收治的147例CSM合并椎管狭窄症患者的临床资料,其中80例行前路椎体次全切除术治疗(A组),67例行后路椎管扩大椎板成形术治疗(B组)。比较2种手术方法治疗前后日本骨科学会(JOA)评分、Cobb角及矢状位垂直距离(SVA)。将2组患者根据T1倾斜角分别分为高T1倾斜角(≥25°)亚组和低T1倾斜角(<25°)亚组,对不同亚组之间的疗效及手术安全性进行比较。结果2组术后JOA评分和Cobb角均高于术前,差异有统计学意义(P<0.05)。A组术后SVA低于术前,差异有统计学意义(P<0.05),B组术后SVA与术前相比差异无统计学意义(P>0.05)。A组术后JOA评分和Cobb角均高于B组,SVA低于B组,差异均有统计学意义(P<0.05)。A组中,高T1倾斜角亚组和低T1倾斜角亚组JOA评分改善效果和后凸畸形发生率比较差异无统计学意义(P>0.05);B组中,低T1倾斜角亚组JOA评分改善效果和后凸畸形发生率优于高T1倾斜角亚组,差异均有统计学意义(P<0.05)。结论相较于后路椎管扩大椎板成形术,前路椎体次全切除术治疗CSM合并椎管狭窄症临床疗效更佳,且有助于改善颈椎矢状位平衡;在高T1倾斜角水平下,应尽可能选择前路椎体次全切除术。

Influence of different kinds of surgical procedures on postoperative outcome and cervical sagittal parameters of patients with cervical spondylotic myelopathy complicated with spinal stenosis

Objective To investigate the influence of anterior cervical corpectomy and posterior laminoplasty on postoperative outcome and cervical sagittal parameters of patients with cervical spondylotic myelopathy(CSM)complicated with spinal stenosis.Methods Totally 147 patients with CSM complicated with spinal stenosis were chosen in the period from March 2010 to August 2015 and divided into 2 groups:group A(80 patients)treated with anterior cervical corpectomy and group B(67 patients)treated with posterior laminoplasty.The Japanese Orthopaedic Association(JOA)score,Cobb’s angle and the sagittal vertical axis(SVA)before and after operation were compared between the groups.Meanwhile,the clinical efficacy and safety of high T1-slope(≥25°)subgroup and low T1-slope(<25°)subgroup were analyzed in both groups.Results TheJOA score and Cobb’s angle after operation were both significantly higher than those before operation in group A and B,all with a significant difference(P<0.05).The SVA after operation was significantly lower than that before operation in group A,with a significant difference(P<0.05),and the SVA at pre-operation had no significant difference compared with that at postoperative in group B(P>0.05).The JOA score and Cobb’s angle after operation were significantly higher in group A than in group B,and the SVA after operation was significantly lower in group A than in group B,all with a significant difference(P<0.05).There was no significant difference in the improvement effects of JOA score and kyphosis incidence between high and low T1-slope subgroups in group A(P>0.05).The improvement effects of JOA score and kyphosis incidence in low T1-slope subgroup of group A were significantly better than those in high T1-slope subgroup,with a significant difference(P<0.05).ConclusionCompared with posterior laminoplasty,anterior cervical corpectomy in the treatment of patients with CSM complicated with spinal stenosis possess the better clinical effects and be helpful in improving sagittal balance of cervical spine,therefore under high T1-slope levels,it should be chosen whenever possible.