摘要
目的比较多节段脊髓型颈椎病伴后凸畸形手术中不同入路方式的价值。方法选取2019年7月至2020年7月本院收治的62例多节段脊髓型颈椎病伴后凸畸形患者作为研究对象,采用奇偶数法分为颈前组与颈后组,每组31例。颈前组行颈前入路,颈后组行颈后入路,比较两组手术指标(手术时间、术中出血量、融合节段数、术后24 h引流量)、颈椎功能指标(Cobb角、颈椎活动度)及手术前后日本骨科协会评估治疗分数(JOA)评分、视觉模拟评分法(VAS)评分。结果颈后组手术时间长于颈前组,术中出血量、融合节段数、术后24 h引流量均多于颈前组,差异有统计学意义(P<0.05)。术后,两组Cobb角均大于术前,颈椎活动度均小于术前,但颈后组Cobb角、颈椎活动度[(12.05±3.81)、(40.78±3.70)°]均大于颈前组[(6.74±2.90)、(34.05±3.36)°],差异有统计学意义(P<0.05)。术后,两组JOA评分均高于术前,VAS评分均低于术前,但颈后组JOA评分[(13.05±1.11)分]低于颈前组[(14.72±1.02)分],VAS评分[(2.31±0.72)分]高于颈前组[(1.07±0.58)分],差异有统计学意义(P<0.05)。结论多节段脊髓型颈椎病伴后凸畸形患者手术入路方式多样,颈前入路手术时间短,术中出血量、融合节段数、术后24 h引流量少,疼痛轻微、颈脊髓功能恢复好,而颈后入路能更好地改善颈椎活动度,且两种入路方式各有优缺点,临床应根据患者颈椎病变程度及后凸畸形程度选择具体入路方式。
Objective To compare the value of different approaches in the surgery of multi-segment cervical spondylotic myelopathy with kyphosis deformity.Methods 62 patients with multi-segment cervical spondylotic myelopathy with kyphosis deformity who were treated in our hospital from July 2019 to July 2020 were selected as the study subjects,they were divided into the anterior cervical group and the posterior cervical group according to the odd even method,with 31 cases in each group.The anterior cervical group undergoing the anterior cervical approach,and the posterior cervical group undergoing posterior cervical approach,the surgical indexes(operation time,intraoperative bleeding volume,number of fusion segments,and postoperative drainage volume at 24 h),cervical functional indexes(Cobb angle,cervical range of motion)and Japanese Orthopaedic Association scores(JOA)and visual analogue scale(VAS)before and after surgery were compared between the two groups.Results The operation time in the posterior cervical group was longer than that in the anterior cervical group,and the intraoperative bleeding volume,number of fusion segment,and postoperative drainage volume at 24 h were all more than those in the anterior cervical group,and the differences were statistically significant(P<0.05).After surgery,the Cobb angle of the two groups was greater than that before surgery,and cervical range of motion was smaller than that before surgery,but the Cobb angle and cervical range of motion in the posterior cervical group([12.05±3.81]and[40.78±3.70]°)were greater than([6.74±2.90]and[34.05±3.36]°)in the anterior cervical group,and the differences were statistically significant(P<0.05).After surgery,the JOA scores of the two groups were higher than that before surgery,and the VAS scores were lower than that before surgery,but the JOA score in the posterior cervical group([13.05±1.11]scores)was lower than([14.72±1.02]scores)in the anterior cervical group,and the VAS score in the posterior cervical group([2.31±0.72]scores)was higher than([1.07±0.58]scores)in the anterior cervical group,and the differences were statistically significant(P<0.05).Conclusion There are various surgical approaches for patients with multi-segment cervical spondylotic myelopathy with kyphosis deformity,the anterior cervical approach has short surgical time,less intraoperative bleeding,number of fused segments,and 24 h postoperative drainage flow,as well as slight pain and good recovery of cervical spinal cord function,while the posterior cervical approach can better improve cervical range of motion,and both approaches have advantages and disadvantages,and the specific approach should be selected according to the degree of cervical spondylosis and kyphotic deformity.
作者
甘泉
GAN Quan(Department of Orthopedics,Yunnan Diannan Central Hospital/Honghe First People's Hospital,Honghe,Yunnan,661199,China)
出处
《当代医学》
2023年第19期156-158,共3页
Contemporary Medicine
关键词
后凸畸形
颈椎切除融合术
颈椎活动度
多节段脊髓型颈椎病
Kyphosis deformity
Cervical spine resection and fusion surgery
Cervical range of motion
Multi-segmental cervical spondylotic myelopathy
