伴交感神经症状的脊髓型颈椎病前路手术中切除后纵韧带的早期疗效研究

目的 分析研究伴交感神经症状的脊髓型颈椎病前路手术中切除后纵韧带的早期疗效。方法 选取浙江省丽水市人民医院2010年10月~2013年10月收治的100例伴交感神经症状的脊髓型颈椎病患者,所有患者均采用颈前路减压植骨融合内固定术进行治疗,根据患者术中后纵韧带处理方式的不同分为去除组（52例）和保留组（48例）。应用20分评分法评估对比两组患者术前及术后3、6、9个月的交感神经症状改善情况;并选用日本矫形外科协会评分（JOA）系统分析患者术后脊髓神经功能的改善情况,选用X线片观察患者植骨融合情况。结果 去除组术前及术后3、6、9个月的交感神经症状评分分别为（7.4±0.3）、（1.9±0.4）、（2.0±0.6）、（2.1±0.7）分,保留组为（7.8±0.5）、（2.8±1.1）、（3.2±1.4）、（4.1±1.8）分。去除组术前及术后3、6、9个月的JOA评分分别为（10.2±1.4）、（12.5±1.3）、（14.3±0.9）、（14.9±1.1）分,保留组为（10.5±1.3）、（10.9±0.6）、（11.2±1.1）、（12.5±0.8）分。两组患者术前交感神经症状评分、JOA评分比较差异无统计学意义（P〉0.05）,但去除组患者术后交感神经症状评分、JOA评分均优于保留组,差异均有统计学意义（均P〈0.05）。此外,去除组患者X线检测显示植骨融合优28例,良14例,优良率为80.7%;保留组患者植骨融合优27例,良11例,优良率为79.2%,两组比较差异无统计学意义（P〉0.05）。去除组有1例伴咽部不适、1例多痰及1例吞咽疼痛,无饮水咳呛;保留组有2例伴多痰、1例吞咽疼痛、1例吞咽困难及1例饮水咳呛。两组患者术后不良反应情况比较差异无统计学意义（P〉0.05）。结论 颈前路减压植骨融合内固定术可有效治疗伴交感神经症状的脊髓型颈椎病,如患者术中行后纵韧带切除操作,患者交感神经症状可显著改善,早期疗效更优。

Study on early efficacy of the posterior longitudinal ligament resection in anterior approach of cervical spondylotic myelopathy with sympathetic symptoms

Objective To analyze and study the early efficacy of the posterior longitudinal ligament resection in anterior approach of cervical spondylotic myelopathy with sympathetic symptoms. Methods One hundred cases of patients with cervical spondylotic myelopathy with sympathetic symptoms admitted to Lishui People＇s Hospital from October 2010 to October 2013 were chosen. All patients were treated with anterior decompression and bone graft fusion with internal fixation, according to the differences of processing mode of intranperative posterior longitudinal ligament, the patients were divided into removal group（52 cases） and retention group（48 cases）. Twenty points scoring method was used to evaluate and compare the improving conditions of sympathetic symptoms before operation and after operation for 3, 6, 9months, and Japanese Orthopedic Association（JOA） score system was used to analyze the improving conditions of postoperative spinal cord function, X-ray was used to observe the conditions of bone graft fusion. Results The sympathetic symptom scores before operation and after operation for 3, 6, 9 months in removal group were（7.4 ±0.3）,（1.9 ±0.4）,（2.0±0.6）,（2.1±0.7） points, which of retention group were（7.8 ±0.5）,（2.8±1.1）,（3.2±1.4）,（4.1±1.8） points. JOA scores before operation and after operation for 3, 6, 9 months in removal group were（10.2±1.4）,（12.5±1.3）,（14.3±0.9）,（14.9±1.1） points, which of retention group were（10.5±1.3）,（10.9±0.6）,（11.2±1.1）,（12.5±0.8） points. There were no statistically significant differences of sympathetic symptom scores and JOA scores between the two groups（P〈0.05）, but the sympathetic symptom scores and JOA scores after operation in removal group were better than those of retention group, the differences were statistically significant（all P〈0.05）. In addition, the X-ray result of bone graft fusion in removal group showed that there were 28 cases of excellent, 14 cases of good, the excell