脊髓型颈椎病前后路手术远期疗效的比较

目的比较脊髓型颈椎病前路和后路手术的远期疗效，探讨脊髓型颈椎病外科治疗时应该如何合理选择手术入路。方法总结了67例经三年以上长期随访的脊髓型颈椎病手术病例，将前、后路手术的手术疗效结合病变的范围进行统计学分析比较。结果单节段病变，23例前路手术术后均改善明显，1例后路手术术后病情恶化；双节段病变，15例前路手术的疗效明显好于11例后路手术（P〈0．05）；三节段病变，6例前路手术和6例后路手术的疗效无显著差别（P〉0．05）；四节段病变，5例后路手术疗效均佳。结论脊髓型颈椎病病变累及单节段和双节段时，采用前路手术比较合理；三节段病变，前路和后路手术均可采用；四节段病变，采用后路手术比较合理。

A long-term outcome comparison of anterior and posterior approaches for cervical spondylotic myelopathy

Objective To compare the long-term outcomes of anterior and posterior approaches for cervical spondylotie myelopathy（CSM） and to explore which approaches should be chosen when dealing with a patient with CSM. Methods 67 patients with CSM after operation were followed up. The outcomes of the operations by anterior or posterior approaches were analyzed by statistic methods according to the number of lesioned segments. Results As the number of lesioned segments was one, the outcomes of the 23 operations by anterior approaches were good but the outcome of the 1 operation by posterior approach was bad. As the number of lesioned segments was two, the outcomes of the 15 operations by anterior approaches were much better than those of the 11 operations by posterior approaches. As the number of lesioned segments was three, there were no difference between the outcomes of the 6 operations of anterior approaches and those of the 6 operations by posterior approaches. As the number of lesioned segments was four, the outcomes of the 5 operations by anterior approaches were satisfactory. Conclusion It is better to choose anterior approaches when dealing with a patient with CSM whose number of lesioned segments is one or two. As the number of lesioned segments is three, anterior and posterior approaches are both selectable. As the number of lesioned segments is four, posterior approaches are preferred.