颈椎前后路联合术治疗脊髓型颈椎病的临床疗效观察

摘要

目的 探讨颈椎前后路联合术治疗脊髓型颈椎病的临床疗效.方法 选取2009年1月～2011年1月我院收治住院的因脊髓型颈椎病行颈椎手术的患者106例,将其按照手术方式的不同分为观察组和对照1组、对照2组,对照1组35例行颈椎前路椎体次全切减压植骨融合内固定术,对照2组35例行颈椎后路单开门椎管扩大成形术,观察组36例行颈椎前后路联合术,术后随访6～12个月,比较三组患者神经功能优良率、手术前后JOA评分及颈椎弧度D值.结果 术后观察组神经功能优良率为86.11%,高于对照1组的71.43%和对照2组的74.28%,观察组与对照组比较差异有统计学意义(χ2 = 9.365,P ＜ 0.05),两对照组间差异无统计学意义(P ＞ 0.05).随访6～12个月,三组患者术后3、6、12个月JOA评分均较术前改善,差异有统计学意义(P ＜ 0.05);且观察组改善较对照组明显(均P ＜ 0.05).颈椎D值对照1组、观察组患者术后较术前有改善,与术前比较差异有统计学意义(均P ＜ 0.05);对照2组术后即刻与随访6、12个月比较,差异有统计学意义(P ＜ 0.05).对照1组术后3例有不同程度咽痛,对照2组2例,观察组2例,均3～5 d后缓解;三组无一例椎动脉损伤患者,无严重并发症发生.结论 颈椎前后路联合术治疗脊髓型颈椎病能达到较好的治疗效果,能较好地恢复和维持颈椎生理弧度,行颈椎后路手术者术后颈椎弧度部分丢失.%Objective To investigate the clinical efficacy of cervical anterior surgery in the treatment of cervical spondylotic myelopathy. Methods 106 cases of patients with cervical spondylotic myelopathy who did cervical spine surgery were selected from January 2009 to January 2011, and were divided into observation group, control group 1 and control group 2. Control group 1 of 35 cases were given anterior cervical vertebral subtotal decompression and fusion with Internal fixation, control group 2 of 35 cases were given posterior cervical single-door laminoplasty, observation group of 36 cases were given cervical anterior surgery, and all patients were followed up for 6 to 12 months, the excellent rate of neurological function, JOA score and cervical curvature of D values were compared between three groups. Results The excellent rate of neurological function of observation group was 86.11%, which was higher than 71.43% of control group 1 and 74.28% of control group 2, there was statistically significant difference between observation group and control group (x2=9.365, P＜0.05). Followed up for 6 to 1 2 months, JOA score of three groups at 3, 6 and 12 months were all improved, the differences were all statistically significant (P＜0.05); and the observation group were Improved better than those of control group (P＜0.05). Cervical D value of control group 1 and observation group were improved than before treatment (P＜0.05); the difference of control group 2 immediate postoperative and follow-up of 6 and 12 months was statistically significant (P＜0.05). There were three cases of varying degrees of sore throat in control group 1, 2 cases In control group 2 and 2 cases in observation group, were all eased after 3 to 5 days; there were no case of vertebral artery Injury in three group patients, and no serious complications occurred. Conclusion The cervical anterior surgery in the treatment of cervical spondylotic myelopathy has good therapeutic effect, can recover and maintain the cervical physiological curvature, some cervical curvature misses In patients with posterior cervical spine surgery.