三种手术方法治疗脊髓型颈椎病临床疗效.doc

三种手术方法治疗脊髓型颈椎病临床疗效 　作者：刘艳兵，申勇，杨大龙，李志远，王林峰 【摘要】 [目的]探讨脊髓型颈椎病(CSM)的三种不同手术方式疗效。[方法]对2002年6月～2007年12月间在本院因CSM行颈椎手术治疗的患者111例，A组颈椎前路椎体次全切减压植骨融合内固定术54例;年龄44～75岁，平均57.1岁。B组颈椎后路单开门椎管扩大成型术33例;年龄41～73岁，平均61岁。C组颈椎后前路联合手术24例;年龄48～78岁，平均62岁。依据随访结果，比较术前、术后随访时JOA评分，颈椎弧度，进行分析研究。[结果]患者定期随访，时间3个月～5年，平均2年，三组患者术后3、6、12个月及最后一次随访JOA评分与术前比较，差异有统计学意义(Plt;0.05)，各组间比较差异无统计学意义(Pgt;0.05)。颈椎D值术后即刻与半年、末次随访时A、C两组组间无统计学差异(P值分别为P=0.434，P=0.492，P=0.569)，B组与另两组均有统计学差异(P均lt;0.05)。[结论]脊髓型颈椎病根据受压部位、病变范围选用不同的三种手术方式均能达到有效的治疗。前路和后前路联合手术能较好的恢复和维持颈椎生理弧度;后路术后颈椎弧度部分丢失。 【关键词】 颈椎病; 手术方法; 临床疗效 　　Abstract: [Objective]To explore the therapeutic effect of three surgical procedures (anterior approach,posterior approach and posterior-anterior approach) for cervical spondylotic myelopathy (CSM). [Methods]A total of 111 patients with cervical spondylotic myelopathy treated with three surgical procedures from June 2002 to December 2007 were retrospectively analyzed. Group A (anterior approach) comprised 54 patients with a mean age of 57.1 years (ranged, 44～75 years).Group B (posterior approach,Laminoplasty) comprised 33 patients with a mean age of 61 years (ranged, 41～73 years).Group C (posterior-anterior approach) comprised 24 patients with a mean age of 62 years (ranged, 48-78 years). All patients were followed-up, neural function and cervical sagittal alignment were recorded. According to JOA score, preoperative and postoperative follow-up scores were compared, improvement rates were calculated, respectively.[Results]Patients were followed up for 3 months to 5 years with an average of 2 years. JOA scores of the three groups at 3, 6,12 months and at the last follow-up after operation were compared with those of preoperation (Plt;0.05). There was no significant difference among the three groups (Pgt;0.05). Cervical sagittal alignment (D numerical value) had no statistical difference at the postoperative and the final follow-up between group A and group C (P=0.434, P=0.492, P=0.569). There was significant difference betw