Objective To compare the early complications of anterior cervical discectomy and fusion(ACDF) and posterior single open-door laminoplasty in the treatment of multilevel cervical spondylotic myelopathy(CSM). Methods A total of 236 patients with multilevel CSM were treated from January 2010 to December 2014,111 by ACDF(anterior group),125 by posterior single open-door laminoplasty(posterior group). Preoperative and final follow-up cervical curvature,Japanese Orthopaedic Association(JOA) score and incidence of complications within 3 months after operation were recorded. Results At the final follow-up,the cervical curvature of anterior group(14.8°±4.1°) was better than that of posterior group(9.5°±2.8°),and the difference was statistically significant(P < 0.05). The JOA score and improvement rate of JOA in the anterior group [(14.6±1.2) and (75.6±3.5)%] were superior to those in the posterior group[(13.2±2.0) and (62.7±5.6)%],and the differences were statistically significant(P < 0.05). A total of 14 patients had early postoperative complications,and the incidence rate was 5.93%,including 5 in the anterior group(4.50%,5/111) and 9 in the posterior group(7.20%,9/125). The most common complication was the superior/recurrent laryngeal nerve injury(5 cases,anterior group);the most serious complication was the spinal cord injury(3 cases,posterior group). There were 2 cases of C5nerve root paralysis,2 of corebrospinal fluid leakage,1 of poor wound healing and 1 of incisional hematoma,all of whom were in posterior group. There was no esophageal fistula,tracheal fistula and death. Conclusion Both ACDF and posterior single open-door laminoplasty have good clinical effect in treatment of multilevel CSM. ACDF can obtain better cervical curvature and nerve function,and the incidence rate of complications is low.%目的 对比颈椎前路椎间盘切除融合术(ACDF)和后路单开门椎板成形术治疗多节段脊髓型颈椎病(CSM)的早期并发症. 方法 2010年1月—2014年12月收治多节段CSM患者236例,111例采用ACDF治疗(前路组)、125例采用颈椎后路单开门椎板成形术治疗(后路组).记录患者术前和末次随访时颈椎曲度、日本骨科学会(JOA)评分以及术后3个月内并发症发生情况. 结果 末次随访时前路组颈椎曲度(14.8°±4.1°)优于后路组(9.5°±2.8°),差异有统计学意义(P < 0.05);前路组末次随访时JOA评分和JOA评分改善率[(14.6±1.2)分、(75.6±3.5)%]均优于后路组[(13.2±2.0)分、(62.7±5.6)%],差异均有统计学意义(P < 0.05).14例患者术后早期发生并发症,发生率为5.93%,其中前路组5例(4.50%,5/111),后路组9例(7.20%,9/125).最常见的并发症为喉上/喉返神经损伤(5例,前路组),最严重的并发症为脊髓损伤(3例,后路组),其余为C5神经根麻痹(2例)、脑脊液漏(2例)、切口愈合不良(1例)、切口血肿(1例),均为后路组病例.无食管、气管瘘及死亡患者. 结论 ACDF和后路单开门椎板成形术治疗多节段CSM均可获得满意的临床疗效,ACDF能获得更好的颈椎曲度和神经功能,且并发症发生率较低.
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