CAJ | 학술논문

目的比较放大镜辅助下与常规开放颈椎前路减压治疗脊髓型颈椎病临床疗效的差别.方法回顾性分析2009年6月至2012年9月间收治的59例脊髓型颈椎病患者,分别接受放大镜辅助下(A组)和常规开放(B组)颈椎椎体次全切除手术减压治疗29例和30例.通过比较两组病例的住院费用、术后住院天数、手术时间、术中出血量、并发症、手术前及随访时的神经功能JOA评分及改善率,评估两种手术方法的临床疗效. 结果所有患者均获得随访3 ～39个月,平均(24.64±10.07)个月.两组患者术前JOA评分、术后住院天数、住院费用等方面比较差异均无统计学意义(P＞0.05).与B组比较,A组术中出血量明显减少,手术时间及术后并发症发生率明显降低,差异均有统计学意义(P＜0.05).随访时,A组JOA评分为14.76±1.35,高于B组的14.03±1.40(P ＜0.05),A组JOA改善率平均为(62.54±14.70)％,较B组的(51.68 ±14.75)％明显增加(P＜0.05)；46例患者(A组21例,B组25例)进行了颈椎MRI复查,A组颈椎椎管及脊髓最狭窄处面积较术前分别增加(52.8±11.8)％和(43.3±15.6)％,均明显高于B组的(41.8±14.2)％和(21.4±7.8)％(P＜0.05). 结论放大镜辅助下颈椎前路手术视野更清晰,可有效减少出血量,减少手术并发症,取得更好的临床效果.
목적 비교방대경보조하여상규개방경추전로감압치료척수형경추병림상료효적차별.방법 회고성분석2009년6월지2012년9월간수치적59례척수형경추병환자,분별접수방대경보조하(A조)화상규개방(B조)경추추체차전절제수술감압치료29례화30례.통과비교량조병례적주원비용、술후주원천수、수술시간、술중출혈량、병발증、수술전급수방시적신경공능JOA평분급개선솔,평고량충수술방법적림상료효. 결과 소유환자균획득수방3 ～39개월,평균(24.64±10.07)개월.량조환자술전JOA평분、술후주원천수、주원비용등방면비교차이균무통계학의의(P＞0.05).여B조비교,A조술중출혈량명현감소,수술시간급술후병발증발생솔명현강저,차이균유통계학의의(P＜0.05).수방시,A조JOA평분위14.76±1.35,고우B조적14.03±1.40(P ＜0.05),A조JOA개선솔평균위(62.54±14.70)％,교B조적(51.68 ±14.75)％명현증가(P＜0.05)；46례환자(A조21례,B조25례)진행료경추MRI복사,A조경추추관급척수최협착처면적교술전분별증가(52.8±11.8)％화(43.3±15.6)％,균명현고우B조적(41.8±14.2)％화(21.4±7.8)％(P＜0.05). 결론 방대경보조하경추전로수술시야경청석,가유효감소출혈량,감소수술병발증,취득경호적림상효과.
Objective To compare the clinical results between loupes and traditional methods which used in anterior cervical decompression for the treatment of cervical spondylotic myelopathy (CSM).Methods A retrospective study of 59 patients with CSM who had undergone cervical decompression from June 2010 to September 2012 was performed.Twenty-nine patients underwent surgery by loupes and 30 patients by traditional methods respectively.Clinical results were assessed by comparing the following parameters between patients who were in the two groups:length of postoperative stay,hospitalization cost,operative time,and estimated blood loss during operation,complications,Japanese Orthopaedic Association (JOA) score and JOA recovery rate.Results All patients were followed up from 3 to 39 months with an average of (24.64 ± 10.07) months.No statistically significant differences were identified in preoperative JOA score,hospitalization cost,and length of stay (P ＞0.05).Statistically significant differences were identified in estimated blood loss during operation,operative time and complications.When follow up,group A experienced the greater improvement than group B in neurological function,both in follow up JOA (14.76 ± 1.35 vs 14.03 ± 1.40,P ＜ 0.05) and JOA recovery rate (62.54 ±14.70 vs 51.68 ± 14.75,P ＜0.05) ; Forty-six cases (21 in group A and 25 in group B) received post-operative MRI check,the narrowest area of spinal canal and spinal cord in group A increased (52.8 ± 11.8) ％ and (43.3 ± 15.6)％,was higher than that (41.8 ± 14.2)％ and (21.4±7.8)％ in group B respectively (P ＜ 0.05).Conclusion Loupes can provide relatively more clear and comfortable vision for the anterior cervical decompression surgery.It can decrease blood loss,reduce complications,which can ensure better clinical results.