摘要
目的 研究前后入路联合手术对脊髓型颈椎病(CSM)患者脊髓功能恢复的影响.方法 回顾性纳入2022年2月至2024年2月在湖北省中西医结合医院择期手术治疗的120例CSM患者,根据术式不同分为前入路手术组(n=40)、后入路手术组(n=40)和联合手术组(n=40).前入路手术组给予前入路颈椎间盘切除融合内固定(ACDF),后入路手术组给予后入路椎板切除椎弓根内固定(PLF),联合手术组给予前后入路联合手术结合ACDF术与PLF术.比较3组患者的手术指标(手术时间、手术出血量、首次离床时间、住院时间),手术前与手术后3个月的脊髓功能[日本骨科协会(JOA)评分]、颈椎恢复情况[颈椎前凸角(Cobb角)与颈椎活动度(ROM)]以及并发症发生情况.结果 联合手术组患者的手术时间、手术出血量、首次离床时间、住院时间分别为(139.64±13.72)min、(317.77±34.52)mL、(5.62±0.61)d、(23.78±4.19)d,均明显高于前入路手术组[(80.41±9.22)min、(116.45±21.38)mL、(2.31±0.28)d、(13.42±1.69)d]及后入路手术组[(112.19±11.48)min、(248.96±26.92)mL、(4.11±0.45)d、(19.75±2.54)d],差异均有统计学意义(P＜0.05);后入路手术组患者的手术时间、手术出血量、首次离床时间、住院时间均明显高于前入路手术组,差异均有统计学意义(P＜0.05).手术后3个月,3组患者的JOA评分均较术前明显增高,且联合手术组患者术后JOA评分为(13.42±1.61)分,明显高于前入路手术组[(8.92±1.04)分]与后入路手术组[(8.75±1.11)分],差异均有统计学意义(P＜0.05);前入路手术组与后入路手术组术后JOA评分比较,差异无统计学意义(P＞0.05).手术后3个月,3组患者的Cobb角均明显大于手术前,ROM均明显小于手术前,差异均有统计学意义(P＜0.05);联合手术组患者术后Cobb角为(8.74±0.84)°,明显大于前入路手术组[(6.67±0.79)°]与后入路手术组[(6.52±0.65)°],ROM 为(40.08±3.162)°,明显大于前入路手术组[(31.25±3.12)°]与后入路手术组[(32.49±2.87)°],差异均有统计学意义(P＜0.05);前入路手术组与后入路手术组术后Cobb角及ROM比较,差异均无统计学意义(P＞0.05).3组患者术后并发症发生率比较,差异无统计学意义(P＞0.05).结论 前后入路联合手术治疗CSM的术源性创伤以及康复时间均高于单纯前入路与后入路手术,但术后脊髓功能恢复更好,颈椎活动度的优势更为明显,而安全性较好,疗效肯定,在满足适应证的情况下更适合临床一线治疗.
Abstract
Objective To study the effect of anterior-posterior combined surgery on spinal functional recovery in patients with cervical spondylotic myelopathy(CSM).Methods The 120 CSM patients treated by elective surgery in Hubei Hospital of Integrated Traditional Chinese and Western Medicine from February 2022 to February 2024 were prospectively divided into anterior surgery group(n=40),posterior surgery group(n=40)and combined surgery group(n=40)according to different operation methods.Anterior cervical discectomy and fusion(AC-DF)was performed in the anterior surgery group,posterior lumbar-fusion(PLF)was performed in the posterior surgery group,anterior and pos-terior approach combined surgery combined with ACDF and PLF was performed in the combined surgery group.The operation indexes(operation time,bleeding volume,first time out of bed,hospitalization time),spinal cord function[Japanese Orthopaedic Association score(JOA)],cervi-cal spine recovery[cervical lordosis angle(Cobb angle)and range of motion(ROM)]before and 3 months after operation and complications were compared among the three groups.Results The operation time,blood loss,first time out of bed and hospitalization time in the combined surgery group were(139.64±13.72)min,(317.77±34.52)mL,(5.62±0.61)d and(23.78±4.19)d,respectively,which were significantly higher than those in the anterior surgery group[(80.41±9.22)min,(116.45±21.38)mL,(2.31±0.28)d,(13.42±1.69)d]and the posterior surgery group[(112.19±11.48)min,(248.96±26.92)mL,(4.11±0.45)d,(19.75±2.54)d],the differences were statisti-cally significant(P＜0.05).The operation time,bleeding volume,first time out of bed time and hospitalization time in the posterior surgery group were significantly higher than those in the anterior surgery group,and the differences were statistically significant(P＜0.05).At three months after operation,the JOA scores of the three groups were significantly higher than those before operation,and the JOA score of the combined surgery group was(13.42±1.61)points,which was significantly higher than that of the anterior surgery group[(8.92±1.04)points]and the posterior surgery group[(8.75±1.11)points],the differences were statistically significant(P＜0.05).There was no statistically significant difference in JOA score between the anterior surgery group and the posterior surgery group(P＞0.05).At 3 months after operation,the Cobb an-gle of the three groups were significantly larger than those before operation,and the ROM were significantly smaller than those before operation,the differences were statistically significant(P＜0.05).The Cobb angle of the combined surgery group at 3 months after operation was(8.74±0.84)°,which was significantly larger than that of the anterior surgery group[(6.67±0.79)°]and the posterior surgery group[(6.52±0.65)°],and the ROM at 3 months after operation was(40.08±3.162)°,which was significantly larger than that of the anterior surgery group[(31.25±3.12)°]and the posterior surgery group[(32.49±2.87)°],the differences were statistically significant(P＜0.05).There was no statistically significant difference in postoperative Cobb angle and ROM between the anterior surgery group and the posterior surgery group(P＞0.05).There was no statistically significant difference in the incidence of postoperative complications among the three groups(P＞0.05).Conclusion The operative trauma and recovery time of anterior and posterior combined surgery for CSM are higher than that of anterior and poste-rior surgery alone,and the postoperative spinal cord function recovery is better,the cervical motion is more obvious,the safety is better,the effica-cy is positive,and it is more suitable for first-line clinical treatment if the indications are met.
维普
万方数据