Yonenobu K, Hosono N, Iwasaki M, Asano M, Ono K
Department of Orthopaedic Surgery, Osaka University Medical School, Japan.
Spine (Phila Pa 1976). 1992 Nov;17(11):1281-4.
A comparative study of surgical results was used to determine the treatment of choice for multisegmental cervical spondylotic myelopathy. Forty-one patients who received subtotal corpectomy and strut grafting (SCS) and forty-two undergoing laminoplasty were followed up for at least 2 years after surgery. Regarding factors known to affect surgical prognosis (age at surgery, duration of symptoms, severity of neurologic deficit, anteroposterior canal diameter, transverse area of the cord at the site of maximum compression, number of levels involved), the two groups were statistically comparable with each other. The severity of neurologic deficits was assessed by the Japanese Orthopaedic Association scale. Results were evaluated in terms of postoperative score and recovery rate. The difference between the recovery rate and final score between the two groups was not statistically significant. Surgical complications were more frequent in the subtotal corpectomy and strut grafting group than in the laminoplasty group. The most frequent complications encountered in the subtotal corpectomy and strut grafting group were related to bone grafting. Spinal alignment worsened in six patients of the laminoplasty group, but none of them suffered from neurologic deterioration. Another disadvantage of subtotal corpectomy and strut grafting was the longer postoperative period of bed rest needed to secure graft stability. We conclude that laminoplasty should be the treatment of choice for multisegmental cervical spondylotic myelopathy when neurologic results, incidence of complications, and postoperative treatment are taken into consideration.
一项关于手术结果的比较研究被用于确定多节段脊髓型颈椎病的首选治疗方法。对41例行椎体次全切除并支撑植骨术（SCS）的患者和42例行椎板成形术的患者进行了术后至少2年的随访。就已知影响手术预后的因素（手术年龄、症状持续时间、神经功能缺损严重程度、椎管前后径、脊髓最大受压部位的横截面积、受累节段数）而言，两组在统计学上具有可比性。神经功能缺损的严重程度采用日本骨科协会评分进行评估。结果根据术后评分和恢复率进行评价。两组之间的恢复率和最终评分差异无统计学意义。椎体次全切除并支撑植骨术组的手术并发症比椎板成形术组更常见。椎体次全切除并支撑植骨术组最常见的并发症与植骨有关。椎板成形术组有6例患者脊柱排列恶化，但均未出现神经功能恶化。椎体次全切除并支撑植骨术的另一个缺点是为确保植骨稳定性需要更长的术后卧床时间。我们得出结论，当考虑神经功能结果、并发症发生率和术后治疗时，椎板成形术应是多节段脊髓型颈椎病的首选治疗方法。
