【摘要】 目的研究前路椎体次全切除钛笼钛板内固定术(ACCF)与颈椎后路微型钛板内固定结合单开门椎管成形术(ELAP)治疗多节段脊髓型颈椎病(MCSM)的近期效果及影像学变化。方法回顾性分析我院82例MCSM手术治疗患者临床资料,根据手术方式不同分为ACCF(n=35)和ELAP(n=47)两组,分析两组手术相关指标及手术前后颈部疼痛VAS评分、JOA评分变化,采用两组术前及术后6个月时X线平片和CT图像计算颈椎曲度、椎管矢状径及颈椎活动度并进行比较。结果 ACCF组手术时间长于ELAP组,术中出血量、术后引流量及平均住院时间少于ELAP组,差异有统计学意义(P﹤0.05);术后6个月时,两组VAS评分明显降低(P﹤0.05),JOA评分明显升高(P﹤0.05),且两组差异无统计学意义(P>0.05);两组颈椎曲度及活动度明显降低(P﹤0.05),椎管矢状径明显增加(P﹤0.05),且ACCF组颈椎曲度及活动度高于ELAP组,椎管矢状径低于ELAP组,差异有统计学意义(P﹤0.05);ACCF组和ELAP组并发症发生率分别为25.71%和29.79%(P>0.05)。结论 ACCF和ELAP治疗MCSM均可有效缓解颈部疼痛,改善颈椎神经功能,其中ACCF对患者创伤较小,有利于促进患者术后康复并减少颈椎曲度及活动度丢失,而ELAP则可扩大脊髓活动空间,能更有效地解除脊髓压迫。更多还原

【Abstract】 Objective To study the short-term effects and imaging changes of anterior cervical corpectomy and fusion(ACCF) and posterior cervical micro-titanium plate fixation combined with expansive laminoplasty(ELAP) in the treatment of multilevel cervical spondylotic myelopathy(MCSM). Methods The clinical data of 82 patients with MCSM surgery in our hospital were retrospectively analyzed. The patients were divided into ACCF group(n=35) and ELAP group(n=47) according to different surgical methods.Surgery-related indexes and neck pain VAS score and JOA score before and after surgery were analyzed in the two groups. X-ray plain film and CT images were used to calculate and compare the cervical curvature, sagittal diameter of spinal canal and cervical vertebra activity before surgery and at 6 months after surgery. Results The operative time in ACCF group was longer than that in ELAP group, and the intraoperative blood loss, postoperative drainage volume and average hospital stay were less than those in ELAP group(P<0.05).At 6 months after surgery, the VAS scores in the two groups were significantly decreases(P<0.05) while the JOA scores were significantly increased(P<0.05), and the differences between the two groups were not statistically significant(P>0.05). The cervical curvature and activity in the two groups were significantly decreased(P<0.05), and the sagittal diameter of spinal canal was increased significantly(P<0.05), and the cervical curvature and activity in ACCF group were higher than those in ELAP group, and the sagittal diameter of spinal canal was lower than that in ELAP group(P<0.05). The incidence rate of complications was 25.71% in ACCF group and 29.79% in ELAP group(P>0.05).Conclusion Both ACCF and ELAP can effectively relieve neck pain and improve cervical nerve function in the treatment of MCSM. Among them, ACCF has less trauma to patients, and it is beneficial to promote postoperative rehabilitation and reduce loss of cervical curvature and activity. And ELAP can enlarge activity space of spinal cord, and it can more effectively relieve spinal cord compression.更多还原