颈椎前路减压分段融合术治疗脊髓型颈椎病的临床分析

Clinical Analysis of Anterior Cervical Decompression and Segmental Fusion in the Treatment of Cervical Spondylotic Myelopathy

摘要: 目的：探究改良颈椎前路减压分段融合术治疗多节段脊髓型颈椎病的临床效果，以期为临床上多节段脊髓型颈椎病的治疗提供理论依据。方法：收集自2015年1月至2020年1月收治我院脊柱外科患者137例，根据手术方案的不同，分成改良前路组和后路组。其中改良前路组颈椎病患者69例，采用改良颈椎前路减压分段融合术进行治疗。后路组包括颈椎病患者68例，采用颈椎后路椎管扩大成形术治疗。统计比较两组患者的疼痛视觉模拟(Visual Analogue Scale, VAS)评分，颈椎的JOA评分等和术后并发症。结果：137例患者入组，随访时间为1.45 ± 0.23年，失访7例，随访率为94.89%。两组患者的一般基准资料，比如性别，年龄，致伤因素和病程等资料比较无统计学差异(P > 0.05)。两组患者术前，术后2 h，术后1天和术后1月的VAS评分比较无统计学差异(P > 0.05)。两组患者术前，术后2 h，术后1天和术后1月的颈椎JOA评分比较无统计学差异(P > 0.05)。改良前路组术后并发症如硬脊膜撕裂，脑脊液渗露，神经损伤，神经根水肿和椎间感染等不良反应发生率要明显低于后路组(P < 0.05)。结论：在改善患者功能，缓解患者疼痛方面，颈椎前路减压分段融合术和后路椎管扩大成形术无明显差异，而改良前路减压分段融合术可以降低术后并发症。

Abstract: Objective: To explore the clinical effect of improved anterior cervical decompression and segmental fusion in the treatment of multi segmental cervical spondylotic myelopathy, so as to provide theo-retical basis for the clinical treatment of multi segmental cervical spondylotic myelopathy. Methods: The 137 patients with spinal surgery in our hospital from January 2015 to January 2020 were collected and divided into improved anterior approach group and posterior approach group ac-cording to different surgical schemes. Among them, 69 patients with cervical spondylosis in the modified anterior approach group were treated with modified anterior cervical decompression and segmental fusion. In the posterior group, 68 patients with cervical spondylosis were treated with posterior cervical laminoplasty. The visual analogue scale (VAS) score, JOA score of cervical spine and postoperative complications were compared between the two groups. Results: 137 patients were enrolled in the study. The follow-up time was 1.45 ± 0.23 years, and 7 cases were lost. The follow-up rate was 94.89%. There was no significant difference in general baseline data, such as gender, age, injury factors and course of disease between the two groups (P > 0.05). There was no significant difference in VAS scores between the two groups before operation, 2 hours after operation, 1 day after operation and 1 month after operation (P > 0.05). There was no significant difference in cervical JOA scores between the two groups before operation, 2 hours after operation, 1 day after operation and 1 month after operation (P > 0.05). The incidence of postoperative com-plications such as dural tear, cerebrospinal fluid leakage, nerve injury, nerve root edema and in-tervertebral infection in the modified anterior approach group were significantly lower than those in the posterior group (P < 0.05). Conclusion: There is no significant difference between anterior cervical decompression and segmental fusion and posterior laminoplasty in improving patients’ function and relieving pain, while improved anterior decompression and segmental fusion can reduce postoperative complications.