Objective To study the curative effect of cervical anterior intervertebral disc resection fusion,cervical posterior laminectomy fusion,and cervical anterior and posterior approach combined treatment in patients with multilevel cervical myelopathy associated with kyphosis. Methods Clinical data of 67 patients were retrospectively analyzed from May 2014 to August 2016. Among them,24 patients underwent cervical anterior discectomy (cervical anterior group),26 patients underwent cervical posterior laminectomy (cervical posterior group),and 17 patients were treated with anterior and posterior combined therapy (anterior and posterior combined group). The course of surgery,the amount of bleeding during surgery,the fusion segment,the postoperative Japanese Orthopedic Association (JOA) evaluated the treatment score,the cervical disability index (NDI) score,the visual analogue Scale (VAS) score,cervical curvature,cervical activity and complications were compared between the three groups,then the choice of surgical approach was evaluated. Results The operation time,the amount of surgical bleeding and the number of fusion segments in anterior and posterior combined group were significantly higher in the cervical anterior group and cervical posterior group (P<0.05). The number of operative bleeding and the number of fusion segments in the cervical posterior group were significantly higher than those in the anterior cervical group (P<0.05). The JOA scores of the anterior cervical group,the posterior cervical group and the anterior and posterior combined group were significantly higher than those before treatment,and the NDI index score was significantly lower than that before treatment (P<0.05). The NDI score of postoperative cervical posterior group was significantly higher than that of cervical anterior group and anteroposterior group,the difference was statistically significant (P<0.05). The VAS score,Cobb angle and cervical vertebra activity of the three groups were significantly lower than those before treatment (P<0.05). The Cobb angle of patients in the cervical anterior group were bigger than that of cervical posterior group and anterior and posterior combined group (P<0.05). The postoperative cervical vertebra activity in patients with cervical posterior group was greater than that in cervical anterior group and anterior and posterior combined group (P<0.05). There was no significant difference in the incidence of complications between the three groups(P>0.05). Conclusion The three kinds of surgical methods have achieved a certain effect,cervical anterior approach in the correction of the kyphosis effect is better than posterior and anterior and posterior combined surgery,cervical posterior approach to reduce the loss of cervical activity is better than the cervical anterior and anterior and posterior combined surgery,anterior and posterior combined surgery has a longer time surgery,more bleeding and fusion segment,it may be suitable for multilevel cervical myelopathy.%目的 比较多节段脊髓型颈椎病伴随后凸畸形患者采用颈椎前路椎间盘切除融合术、颈椎后路椎板切除融合术及前后路联合治疗的疗效.方法 回顾性分析2014年5月至2016年8月67例多节段脊髓型颈椎病伴随后凸畸形患者的临床资料,其中采用颈椎前路椎间盘切除融合术(颈椎前路组)患者24例,采用颈椎后路椎板切除融合术(颈椎后路组)患者26例,采用前后路联合治疗(前后路联合组)患者17例.比较三组患者的手术时间、术中出血量、融合节段、术后日本骨科协会(JOA)评估治疗评分、颈椎功能障碍指数(NDI)评分、疼痛量表(VAS)评分、颈椎曲度、颈椎活动度、并发症等的差异,评估手术方式的选择.结果 前后路联合组患者的手术时间、手术出血量、融合节段数均明显多于颈椎前路组和颈椎后路组,差异有统计学意义(P<0.05).颈椎后路组患者手术出血量和融合节段数明显大于颈椎前路组,差异有统计学意义(P<0.05).术后颈椎前路组、颈椎后路组以及前后路联合组患者的JOA评分均明显高于治疗前,NDI指数评分均明显低于治疗前,差异有统计学意义(P<0.05).术后颈椎后路组患者NDI指数评分明显高于颈椎前路组和前后路联合组,差异有统计学意义(P<0.05).术后三组患者VAS评分、Cobb角及颈椎活动度均明显小于治疗前,差异有统计学意义(P<0.05).术后颈椎后路组患者和前后路联合组患者的Cobb角均小于颈椎前路组,差异有统计学意义(P<0.05),颈椎后路组患者术后颈椎活动度大于颈椎前路组和前后路联合组,差异有统计学意义(P<0.05).三组并发症发生率差异无统计学意义(P>0.05).结论 三种手术方式均取得一定疗效,颈椎前路手术方式在矫正后凸方面效果优于后路和前后路联合术,颈椎后路手术方式对减少颈椎活动度的丧失方面效果优于前路和前后路联合术,前后联合入路手术的方式手术时间更长,出血量更多,融合节段更多,适用于多节段脊髓型颈椎病.
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