【摘要】 背景:多节段脊髓型颈椎病因为存在多个水平脊髓的受压,且往往脊髓的前后均有压迫,故手术的入路和方式一直有较多的选择,究竟何种方式疗效更好,并发症更少,目前仍未达成一致。目的:观察前路减压植骨内固定对多节段脊髓型颈椎病的治疗效果,并与后路单开门椎管扩大成形术进行比较。设计:对比分析。单位:中南大学湘雅医院骨科,柳州市人民医院骨科。对象:选择2000-01/2005-06在中南大学湘雅医院骨科行手术治疗的多节段脊髓型颈椎病患者68例,根据选择术式不同分为前路手术组33例和后路手术组35例,2组基线资料有可比性。方法:①前路手术组:行椎间植骨融合内固定,33例中自体髂骨块植入17例,植入Cage骨笼自体骨混合同种异体骨11例,钛网加自体骨混合同种异体骨植骨5例;长节段自锁颈椎前路钢板内固定,其中Orion钢板12例,Zephir钢板13例,Codman钢板8例。②后路手术组:全椎板切除减压15例,单开门椎管扩大成形术20例,术后负压引流,颈托固定3个月。主要观察指标:①术前和术后按照JOA评分系统进行评分并计算恢复率,JOA评分为0～17分,评分越高脊髓损害症状越轻。②MRI测量硬脊膜囊矢状径并进行计算。结果:68例均进入结果分析。①后路手术组平均手术时间和手术出血量少于前路手术组(P<0.05)。②前路手术组JOA评分恢复率和硬脊膜囊膨胀回复率高于后路手术组[(58.28±7.16)%,(42.71±5.85)%;(45.64±6.56)%,(37.65±5.75)%;P均<0.05]。③术后随访≥6个月,前路手术组所有病例均行不同方法植骨后均融合,融合率100%,融合时间平均4.6个月,无钢板螺钉松动断裂。结论:后路手术操作简单,手术时间短,但其疗效不如前路植骨钢板内固定减压手术。更多还原

【Abstract】 BACKGROUND: Compression occurs in several horizontal spinal cords of patients with multilevel cervical spondylotic myelopathy (CSM), especially compression is attacked on both ends of spinal cord. Therefore, there are so many choices of approach and way for operation. However, which approach and way have good effects and few complications is still controversial up to now. OBJECTIVE: To observe the therapeutic effect of anterior multilevel decompression and internal fixation on multilevel CSM and compare with posterior mono-open-door vertebral canal expanding laminoplasty. DESIGN: Contrast analysis. SETTING: Department of Orthopaedics, Xiangya Hospital of South China University; Department of Orthopaedics, People’s Hospital of Liuzhou. PARTICIPANTS: A total of 68 patients with multilevel CSM were selected from the Department of Orthopaedics, Xiangya Hospital of South China University from January 2000 to June 2005. All patients were divided into anterior approach surgery group (n =33) and posterior approach surgery group (n =35). Baseline data between the two groups were comparable. METHODS: ① Anterior approach surgery group: All 33 patients received bone-transplanting and internal fixation through cervical spine. Among them, auto-iliac bone-graft was transplanted into 17 cases, Cage auto-bone graft combining with allogenic bone was transplanted into 11 cases, and titan-net and auto-bone combining with allogenic bone was transplanted into 5 cases. In addition, long segments were dealt with internal fixation of anterior cervical spine locking plate (CSLP). Among them, 12 cases used Orion plate, 13 cased used Zephir palte, and 8 cases used Codman plate. ② Posterior approach surgery group: Fifteen patients received total laminectomy for decompression and other twenty patients received mono-open-door vertebral canal expanding laminoplasty. After laminoplasty, all patients received negative pressure and neck support fixation for three months. MAIN OUTCOME MEASURES: ① Scores were measured based on JOA evaluating system before and after laminoplasty to calculate recovery rate. The scores of JOA ranged from 0 to 17. The higher the scores were, the milder the spinal cord damage was. ② Magnetic resonance image (MRI) was used to measure and calculate the sagittal diameter of dural sac. RESULTS: A total of 68 patients were involved in the final analysis. ① Mean operative time and bleeding volume were respectively shorter and less in the posterior approach surgery group than those in the anterior approach surgery group (P < 0.05). ② Recovery rates were higher in the anterior approach surgery group than those in the posterior approach surgery group [(58.28±7.16)%, (42.71±5.85)%; (45.64±6.56)%, (37.65±5.75)%; P < 0.05]. ③ Follow up lasted for more than 6 months. Fusion rate in the anterior approach surgery group was 100%, and mean fusion time was 4.6 months. Mobilization and breakage of plate and screw were not observed during the laminectomy. CONCLUSION: The posterior approach surgery is simple and spends a short-term duration, but the effect of posterior approach surgery is inferior to anterior approach decompression.更多还原