CAJ | 학술논문

目的探讨不同手术方案治疗高龄多节段颈椎病患者的临床疗效. 方法回顾2007年5月至2014年5月在本院骨科接受手术治疗的53例(年龄≥70岁)多节段颈椎病患者,根据手术入路的方式分为前路组(22例)与后路组(31例).比较两组患者的手术时间、术中失血量、住院时间、术后并发症、日本骨科学会(JOA)评分、颈椎功能障碍指数(NDI)评分、临床症状主观改善及术后植骨融合情况. 结果前路组手术时间(2.7±0.5)h明显长于后路组(1.9±0.3)h(P＜0.05);前路组术中出血(90.0±50.4)ml少于后路组(160.7±40.5) ml(P＜0.05).前路组住院时间(10.3±2.5)d少于后路组(15.7±3.6)d(P＜0.05).前路组分术后6个月的JOA评分高于后路组[(14.7±0.8)、(13.8±1.2)分,(P＜0.05)],但末次随访JOA评分两组间差异无统计学意义[前路组:(14.8±1.2)分,后路组:(14.7±1.8)分,P＞0.05].术后3个月、6个月、12个月及末次随访时前路手术组的NDI评分均比后路组低.41例影像学随访患者在术后3个月随访时,有16例前路未达到骨性融合,在术后1年随访时均达到骨性融合标准,前路组中有4例出现钛网下沉(＜3 mm). 结论颈椎前路减压融合术与颈椎后路椎管成形术治疗高龄多节段颈椎病患者均可获得良好的临床疗效,在肢体功能恢复时间、颈部功能评估方面前者具有一定的优势.在排除前路融合手术禁忌的前提下,颈椎前路减压融合术不失为治疗高龄多节段颈椎病的一种良好选择.
목적 탐토불동수술방안치료고령다절단경추병환자적림상료효. 방법 회고2007년5월지2014년5월재본원골과접수수술치료적53례(년령≥70세)다절단경추병환자,근거수술입로적방식분위전로조(22례)여후로조(31례).비교량조환자적수술시간、술중실혈량、주원시간、술후병발증、일본골과학회(JOA)평분、경추공능장애지수(NDI)평분、림상증상주관개선급술후식골융합정황. 결과 전로조수술시간(2.7±0.5)h명현장우후로조(1.9±0.3)h(P＜0.05);전로조술중출혈(90.0±50.4)ml소우후로조(160.7±40.5) ml(P＜0.05).전로조주원시간(10.3±2.5)d소우후로조(15.7±3.6)d(P＜0.05).전로조분술후6개월적JOA평분고우후로조[(14.7±0.8)、(13.8±1.2)분,(P＜0.05)],단말차수방JOA평분량조간차이무통계학의의[전로조:(14.8±1.2)분,후로조:(14.7±1.8)분,P＞0.05].술후3개월、6개월、12개월급말차수방시전로수술조적NDI평분균비후로조저.41례영상학수방환자재술후3개월수방시,유16례전로미체도골성융합,재술후1년수방시균체도골성융합표준,전로조중유4례출현태망하침(＜3 mm). 결론 경추전로감압융합술여경추후로추관성형술치료고령다절단경추병환자균가획득량호적림상료효,재지체공능회복시간、경부공능평고방면전자구유일정적우세.재배제전로융합수술금기적전제하,경추전로감압융합술불실위치료고령다절단경추병적일충량호선택.
Objective To investigate the clinical effect of different surgical approaches on multi-level cervical spondylosis in elderly patients.Methods A total of 53 aged patients with multi-level cervical spondylosis (≥70 years old) who received operation in our department during May 2007 to May 2014 were retrospectively studied, and divided into anterior cervical surgical group (n=22) and posterior cervical group (n=31), according to the surgical approach.The operation duration, intraoperative blood loss, hospitalization time, postoperative complications, Japanese orthopedics association (JOA) scores, Neck disability index (NDI), postoperative subjective improvement of clinical symptoms and spinal fusion of the two groups were evaluated and compared respectively.Results The mean operative time was longer in the anterior surgical group than in the posterior surgical group [(2.7±0.5)h vs.(1.9±0.3) h, P＜0.05].The average blood loss of the anterior surgical group was less than that of posterior surgical group [(90.0±50.4) ml vs.(160.7±40.5)ml, P＜0.05].The hospitalization time of the anterior surgical group was less than that of posterior surgical group [(10.3±2.5) d vs.(15.7±3.6) d, P＜0.05].Postoperative JOA score of anterior surgical group was higher than that of posterior surgical group 6 months after surgery [(14.7 ±0.8)vs.(13.8±1.2), P＜0.05], while there was no significant difference in JOA score between the two groups up to the last follow-up [(14.8±1.2) vs.(14.7±1.8), P＞0.05].NDI score was lower in anterior surgical group than in posterior surgical group 3, 6, 12 months after operation and at the last follow-up.Among the 41 patients, radiographic outcomes showed that there were 16 cases of anterior surgical group with no bony fusion at the follow-up 3 months after operation, and all the 16 patients achieved bony fusion at the follow-up 1 year after operation, and there were 4 cases with titanium mesh subsidence (＜ 3 mm).Conclusions Both anterior cervical decompression and fusion and posterior cervical single open-door laminoplasty have good efficacy in the treatment of multilevel cervical spondylosis in elderly patients, which have advantages on the limb functional recovery time and cervical function assessment.When anterior cervical surgical contraindications were excluded, the anterior cervical decompression and fusion may be a good choice for the treatment of multilevel cervical spondylosis in aged patients.