多节段脊髓型颈椎病前路减压与节段融合后路扩大椎管成形术的临床疗效及安全性对比

Clinical Efficacy and Safety of Anterior Cervical Decompression versus Segmental Fusion and Posterior Expansive Canal Plasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy.

机构信息

Department of Orthopedics, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, Hangzhou 310014, China.

Department of Hematology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, Hangzhou 310014, China.

出版信息

J Healthc Eng. 2022 Apr 11;2022:7696209. doi: 10.1155/2022/7696209. eCollection 2022.

OBJECTIVE

To compare the clinical efficacy and safety of anterior cervical decompression and segmental fusion and posterior expansive canal plasty in the treatment of multisegment cervical myelopathy.

METHODS

Retrospective analysis was performed of 56 cases of multisegment cervical myelopathy patients admitted from July 2018 to June 2021, 32 male patients and 24 females, aged 56.9 ± 12.8 years with an average duration of 10.6 ± 3.2 years. All patients' preoperative imaging examination revealed multiple-segmented cervical disc herniation and had clinical manifestations of cervical myelopathy.

RESULTS

No neurovascular complications occurred in both groups, and 24 to 36 months of follow-up (mean 28.6 months) were obtained. The height of the cervical spondylosis segment was higher than that 2 weeks after surgery ( < 0.05), and the curvature of the cervical spine was significantly lower than that before surgery. There was no statistical significance in the height of the anterior column and curvature of the cervical vertebra at 2 weeks after surgery and at the last follow-up ( > 0.05). There were statistically significant differences in anterior curvature of the cervical spine between the two groups at 2 weeks after surgery and the last follow-up ( < 0.05). Japanese Orthopaedic Association (JOA) scores in both groups recovered significantly after surgery. At 3 months and the last follow-up, the improvement rate of JOA score in the anterior approach group was significantly higher than that in the posterior approach group ( < 0.05), and the improvement rate of JOA score in the anterior approach group was also better than that in the posterior approach group ( < 0.05).

CONCLUSION

This segmented anterior fusion procedure can effectively restore the anterior cervical column height and can significantly improve spinal cord function compared with posterior spinal canal enlargement plasty, thus could be considered an effective option for the treatment of multisegment cervical myelopathy.

目的

比较前路颈椎减压融合术与后路椎管扩大成形术治疗多节段脊髓型颈椎病的临床疗效及安全性。

方法

回顾性分析 2018 年 7 月至 2021 年 6 月收治的 56 例多节段脊髓型颈椎病患者，男 32 例，女 24 例；年龄 56.9±12.8 岁，平均病程 10.6±3.2 年。所有患者术前影像学检查均显示多节段颈椎间盘突出，均有脊髓型颈椎病的临床表现。

结果

两组均无神经血管并发症发生，获得 24~36 个月（平均 28.6 个月）随访。术后 2 周及末次随访时颈椎病变节段高度均高于术后 2 周（ < 0.05），颈椎曲度均明显低于术前（ < 0.05）。术后 2 周及末次随访时颈椎前柱高度及颈椎曲度比较差异均无统计学意义（ > 0.05）。术后 2 周及末次随访时两组颈椎前凸曲度比较差异均有统计学意义（ < 0.05）。两组术后日本骨科协会（JOA）评分均显著提高。术后 3 个月及末次随访时，前路组 JOA 评分改善率明显高于后路组（ < 0.05），且前路组 JOA 评分改善率也优于后路组（ < 0.05）。