【摘要】：背景:目前多節(jié)段脊髓型頸椎病治療的主要目的是解除脊髓的壓迫,最大限度恢復(fù)頸椎的穩(wěn)定性。目的:頸前路間盤切除植骨融合鈦板內(nèi)固定和頸后路單開(kāi)門椎管成形治療多節(jié)段脊髓型頸椎病的特點(diǎn)分析。方法:67例多節(jié)段脊髓型頸椎病患者按照治療方式的不同分為2組:經(jīng)頸前路間盤切除植骨融合鈦板內(nèi)固定組和經(jīng)頸后路單開(kāi)門椎管成形組。隨訪12個(gè)月觀察兩組患者頸椎活動(dòng)度、頸椎曲度指數(shù)等頸椎的穩(wěn)定性變化,進(jìn)行軸性癥狀目測(cè)類比評(píng)分和JOA評(píng)分,分別記錄手術(shù)時(shí)間、出血量及不良反應(yīng)發(fā)生率。結(jié)果與結(jié)論:①兩組內(nèi)固定后均丟失部分頸椎活動(dòng)度,頸后路單開(kāi)門椎管成形組頸椎活動(dòng)度丟失量多于頸前路間盤切除植骨融合鈦板內(nèi)固定組(P0.05);②頸前路間盤切除植骨融合鈦板內(nèi)固定組內(nèi)固定后頸椎曲度指數(shù)較內(nèi)固定前更接近生理曲度(P0.05),頸后路單開(kāi)門椎管成形組未見(jiàn)明顯改善;③兩組軸性癥狀較治療前明顯緩解(P0.05),頸后路單開(kāi)門椎管成形組軸性癥狀緩解不如頸前路間盤切除植骨融合鈦板內(nèi)固定組(P0.05);④兩組神經(jīng)功能比治療前均得到明顯改善(P0.05),組間差異無(wú)顯著性意義(P0.05);(5)術(shù)中出血量頸后路單開(kāi)門椎管成形組明顯多于頸前路間盤切除植骨融合鈦板內(nèi)固定組(P0.05);(6)頸前路間盤切除植骨融合鈦板內(nèi)固定組內(nèi)固定后出現(xiàn)聲音嘶啞、吞咽困難發(fā)生率為19%,頸后路單開(kāi)門椎管成形組患者出現(xiàn)傷口感染、腦脊液漏、C5神經(jīng)根麻痹發(fā)生率為9%;(7)結(jié)果說(shuō)明,頸前路間盤切除植骨融合鈦板內(nèi)固定在恢復(fù)頸椎病變節(jié)段的生理曲度以及椎間隙高度,重建頸椎的穩(wěn)定性方面好于頸后路單開(kāi)門椎管成形,但有出現(xiàn)聲音嘶啞和吞咽困難風(fēng)險(xiǎn)。后路單開(kāi)門椎管成形操作較為簡(jiǎn)單,但出血量和并發(fā)癥相對(duì)較多。因此需要根據(jù)臨床醫(yī)師的操作技巧和患者的實(shí)際情況慎重選擇治療方式。
[Abstract]:Background: the main purpose of the treatment of multilevel cervical Spondylotic myelopathy is to relieve the compression of the spinal cord and restore the stability of the cervical spine to the maximum extent. Objective: to analyze the characteristics of anterior cervical discectomy and bone graft fusion with titanium plate fixation and posterior cervical open door spinal canal plasty for multilevel cervical Spondylotic myelopathy. Methods 67 patients with multisegmental cervical Spondylotic myelopathy were divided into two groups according to different treatment methods: anterior cervical disc resection and fusion with titanium plate fixation group and single open door spinal canal formation group via posterior cervical approach. The stability of cervical vertebrae such as cervical movement and cervical curvature index were observed after 12 months follow-up. The axial symptom visual analogue score and JOA score were used to record the time of operation, the amount of blood loss and the incidence of adverse reactions. Results and conclusion both groups lost part of cervical motion after internal fixation. Loss of cervical movement in posterior cervical open door spinal canal formation group was more than that in anterior cervical intervertebral disc resection, bone graft fusion, titanium plate fixation group (P0.05). Cervical curvature index was higher in anterior cervical intervertebral disc resection and bone graft fusion titanium plate fixation group than in internal fixation group. It was closer to the physiological curvature before fixation (P0.05), but there was no significant improvement in the posterior cervical open door spinal canal formation group. 3Axial symptoms in the two groups were significantly relieved than before treatment (P0.05). The axonal symptom relief in the posterior cervical open door laminoplasty group was not as good as that in the anterior cervical intervertebral disc resection and fusion titanium plate fixation group (P0.05). The nerve function of the two groups was significantly improved than that of the pre-treatment group (P0.05). There was no significant difference between the two groups (P0.05) (P0.05); (5) the amount of intraoperative bleeding in the posterior cervical open door spinal canal formation group was significantly higher than that in the anterior cervical intervertebral disc resection and bone graft fusion titanium plate fixation group (P0.05); (6) the anterior cervical intervertebral disc resection and bone graft fusion titanium plate internal fixation group was significantly higher than that in the anterior cervical intervertebral disc resection and bone graft fusion titanium plate fixation group (P0.05); (6). And then there was hoarseness, The incidence of dysphagia was 19. The incidence of wound infection and cerebrospinal fluid leakage C5 nerve root paralysis was 9 in the posterior cervical open door laminoplasty group. (7) the results showed that, Anterior disc resection and fusion with titanium plate were better in restoring the physiological curvature and intervertebral space height of cervical spondylosis and reconstructing the stability of cervical vertebrae than in posterior cervical open door spinal canal formation, but there was a risk of hoarseness and dysphagia. Posterior open-door spinal canal formation is relatively simple, but the amount of bleeding and complications are relatively high. Therefore, according to the clinician's operation skill and the patient's actual situation, the treatment method should be carefully selected.
【作者單位】： 天津市人民醫(yī)院脊柱一科;
【分類號(hào)】：R687.3

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