前路减压融合术与后路单开门椎管扩大成形术治疗脊髓型颈椎病的前瞻性研究长期结果
Long-term results of a prospective study of anterior decompression with fusion and posterior decompression with laminoplasty for treatment of cervical spondylotic myelopathy.
作者信息
Hirai Takashi, Yoshii Toshitaka, Sakai Kenichiro, Inose Hiroyuki, Yamada Tsuyoshi, Kato Tsuyoshi, Kawabata Shigenori, Arai Yoshiyasu, Shinomiya Kenichi, Okawa Atsushi
机构信息
Department of Orthopedic Surgery, Tokyo Medical and Dental University, Japan.
Department of Orthopedic Surgery, Tokyo Medical and Dental University, Japan.
出版信息
J Orthop Sci. 2018 Jan;23(1):32-38. doi: 10.1016/j.jos.2017.07.012. Epub 2017 Oct 18.
BACKGROUND
There have been no prospective studies comparing anterior surgery and posterior method in terms of long-term outcomes. The purposes of this study is to clarify whether there is any difference in long-term clinical and radiologic outcomes of anterior decompression with fusion (ADF) and laminoplasty (LAMP) for the treatment of cervical spondylotic myelopathy (CSM).
METHODS
Ninety-five patients were prospectively treated with ADF or LAMP for CSM in our hospital from 1996 through 2003. On alternate years, patients were enrolled to receive ADF (1997, 1999, 2001, and 2003: ADF group, n = 45) or LAMP (1996, 1998, 2000, and 2002: LAMP group, n = 50). We excluded 19 patients who died during follow-up, and 25 who were lost to follow-up. Clinical outcomes were evaluated by the recovery rate of the Japanese Orthopaedic Association (JOA) score between the two groups. Sagittal alignment of the C2-7 lordotic angle and range of motion (ROM) in flexion and extension on plain X-ray were measured.
RESULTS
Mean age at the time of surgery was 58.3 years in the ADF group and 57.9 years in the LAMP group. Mean preoperative JOA score was 10.0 and 10.5, respectively. Mean recovery rate of the JOA score at 3-5 years postoperatively was significantly higher in the ADF group (p < 0.05). Reoperation was required in 1 patient for pseudarthrosis and in 1 patient for recurrence of myelopathy in the ADF group; no patient in the LAMP group underwent a second surgery. There was a significant difference in maintenance of the lordotic angle in the ADF group compared with the LAMP group (p < 0.05), but not in ROM.
CONCLUSIONS
Both ADF and LAMP provided similar good outcomes at 10-year time-point whereas ADF could achieve more satisfactory outcomes and better sagittal alignment at the middle-term. However, the incidence of reoperation and complication in the ADF group were higher than those in the LAMP group.
STUDY DESIGN
A prospective comparative study (not randomized).
背景
尚无前瞻性研究比较前路手术和后路手术的长期疗效。本研究旨在明确前路减压融合术（ADF）和椎板成形术（LAMP）治疗脊髓型颈椎病（CSM）的长期临床和影像学疗效是否存在差异。
方法
1996年至2003年，我院对95例CSM患者进行了ADF或LAMP的前瞻性治疗。每隔一年，患者被纳入接受ADF（1997年、1999年、2001年和2003年：ADF组，n = 45）或LAMP（1996年、1998年、2000年和2002年：LAMP组，n = 50）治疗。我们排除了19例随访期间死亡的患者和25例失访患者。通过两组间日本骨科协会（JOA）评分的恢复率评估临床疗效。在普通X线片上测量C2-7前凸角的矢状位对线以及屈伸活动度（ROM）。
结果
ADF组手术时的平均年龄为58.3岁，LAMP组为57.9岁。术前平均JOA评分分别为10.0和10.5。ADF组术后3至5年JOA评分的平均恢复率显著更高（p < 0.05）。ADF组有1例因假关节形成需再次手术，1例因脊髓病复发需再次手术；LAMP组无患者接受二次手术。与LAMP组相比，ADF组在维持前凸角方面存在显著差异（p < 0.05），但在ROM方面无差异。
结论
在10年时间点，ADF和LAMP均取得了相似的良好疗效，而ADF在中期可获得更满意的疗效和更好的矢状位对线。然而，ADF组的再次手术率和并发症发生率高于LAMP组。
研究设计
前瞻性比较研究（非随机）。
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