椎间撑开颈前路减压植骨术与传统非撑开减压术治疗脊髓型颈椎病比较研究

目的 比较评价椎间撑开与传统非撑开颈前路减压植骨术对脊髓型颈椎病的治疗效果.方法 2001年4月-2004年8月,应用传统环锯颈前路开窗减压、植骨、钛板内固定术治疗脊髓型颈椎病53例(A组).其中男30例,女23例;年龄31～69岁.病程7个月～15年,1个节段22例,2个节段24例,3个节段7例.应用颈前路自动拉钩及Caspar椎体问撑开器系统,采用单节段单纯椎间盘切除,经椎间隙入路或多节段分别行椎间盘切除、椎管潜式扩大减压、植骨、钛板内固定术治疗脊髓型颈椎病68例(B组).其中男48例,女20例;年龄33～74岁;病程5个月～18年.1个节段23例,2个节段34例,3个节段11例.X线片及MRI示不同程度椎间盘退变、突出,颈髓受压.统计比较手术时间、失血量、颈椎病变节段单位手术前后高度差、椎体融合时间、手术并发症.术前、术后脊髓功能采用JOA评分标准评定改善率.结果 有92例获随访3～5年,平均3.5年;A组42例,B组50例.A组手术时间、失血量、椎体融合时间、颈椎病变节段单位手术前后高度差以及脊髓功能改善率分别为(76.80±28.41)min、(564.00±181.96)mL、(12.10±3.58)周、(1.30±0.67)mm和0.49%4±0.14%,B组分别为(57.90±15.01)min、(317.50±136.92)mL、(9.75±1.36)周、(3.00±0.56)mm和0.71%±0.17%,两组比较差异均有统计学意义(P＜0.05).术后并发症A组脊髓损伤、钢板螺钉松动移位、植骨块松动各1例,髂骨区功能障碍4例;B组无并发症发生.结论 以椎间撑开颈前路椎间减压植骨内固定术治疗脊髓型颈椎病整体疗效显著优于传统术式,并进一步完善了颈前路椎间减压植骨内固定术,使其更为科学、安全.

A COMPARATIVE STUDY OF ANTERIOR DECOMPRESSION APPROACH BY USING CERVICAL RETRACTOR SYSTEMS AND TRADITIONAL SURGICAL APPROACH TO TREAT CERVICAL SPONDYLOSIS

OBJECTIVE: To compare and evaluate the whole effect of anterior decompression approach to treat cervical spondylotic myelopathy by using cervical retractor systems and the traditional surgical approach. METHODS: From April 2001 to August 2004, group A included 30 males and 23 females aging from 31 to 69 years, and the involved time was from 7 months to 15 years. Involved segments included 22 one-segments, 24 two-segments and 7 three-segments. In all 53 cases, anterior windowing decompression and fusion with autograft and titanium plate internal fixation by using traditional circular saw were performed. Group B included 48 males and 20 females aging from 33 to 74 years, and the involved time was from 5 months to 18 years. Involved segments included 23 one-segments, 34 two-segments and 11 three-segments. In all 68 cases, anterior undermined far-reaching decompression and fusion with autograft and titanium plate internal fixation by using removing disc merely in the single-level or separately in the multilevels employing self-retractor and Caspar cervical retractor systems via interspinal approach were performed. X-rays and MRI showed cervical disc degeneration, herniation and spinal cord compression. The surgery time, loss of blood, vertebral body fusion time, difference in height of involved segments pre- or postoperatively and complications were counted up and compared between the two groups. Improvement rate of spinal function pre- or postoperatively were valued by using JOA score. RESULTS: A total of 92 cases including 42 of group A and 50 of group B were followed up for 3 to 5 years, mean 3.5 years. In group A, surgery time, loss of blood, time of vertebral body fusion, difference in height of involved segments pre- or postoperatively, and improvement ratio of spinal function were (76.80 +/- 28.41) min, (564.00 +/- 181.96) mL, (12.10 +/- 3.58) weeks, (1.30 +/- 0.67) mm and 0.49% +/- 0.14%, respectively. In group B, they were (57.90 +/- 15.01) min, (317.50 +/- 136.92) mL, (9.75 +/- 1.36) weeks, (3.00 +/- 0.56) mm and 0.71% +/- 0.17%, respectively. The differences between the two groups were significant in all measured values (P < 0.05). Complications occurred in 7 cases of group A including 1 spinal cord injury, 1 plate displacement, 1 bonegraft displacement and 4 disfunctions of iliac region. No complication happened in group B. CONCLUSION: Anterior decompression approach using cervical retractor systems is significantly superior to the traditional approach as to the whole effect to treat cervical spondylotic myelopathy, and further perfects the traditional anterior decompression approach. The modified approach is scientific, safe and easily spread.