前路和后路手术方式治疗老年脊髓型颈椎病的疗效比较-论文.pdf

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1、748实用老年医学2014年9月第28卷第9期PractGeriatr，Sep2014，Vo1．28，No．9前路和后路手术方式治疗老年脊髓型颈椎病的疗效比较王明贵饶锐强王海【摘要】目的探讨老年脊髓型颈椎病(cervicalspondyloticmyelopathy，CSM)不同入路手术的疗效，以期提高老年CSM的临床效果。方法选择接受手术治疗的160例老年CSM患者，根据手术入路的方式分为前路组(n=80)与后路组(n=80)。前路组患者接受颈椎前路减压植骨融合术；后路组患者接受颈椎后路单开门椎管成形术。观察并比较2组患者的手术时间、术中及术后并发症、脊髓神经

2、功能优良率及手术前后日本骨科学会评分(JOA)的变化。结果前路组平均手术时间比后路组明显缩短(P<0．05)；前路组平均术中出血量显著少于后路组(PO．05)；2组术后JOA评分均较术前明显改善，差异有统计学意义(P<0．05)，术后前路组JOA评分改善优于后路组(P<0．05)。结论颈椎前路减压植骨融合术和颈椎后路单开门椎管成形术治疗CSM均具有较好的疗效；合理选择好手术适应证可提高老年CSM患者的临床疗效及减少并发症的发生。【关键词】老年人；脊髓型颈椎病；颈椎前路减压植骨融合术；颈椎后路单开门椎管成形

3、术[中图分类号]R681．55[文献标识码]Adoi：10．3969／j．issn．1003—9198．2014．09．013Eficacyofanteriorandposteriorcervicalapproachesinthetreatmentforcervicalspond)loticmyelopathyintheelderlyWANGMing—gui，RAORui—qiang，WANGHai．DepartmentofOrthopaedics，ChongqingFulingCentralHospital，Chongqing408000，China【Abst

4、ract】ObjeetiveToinvestigatetheeffectofvariedsurgicalapproachesinthetreatmentforcervicalspondy—loticmyelopathy(CSM)intheelderly，andtoimprovethespinalcordfunction．Methods160elderlypatientswithCSMwererandomlydividedintoanteriorcervicalsurgicalgroupandposteriorcervicalsurgicalgroup．with8

5、0casesineachgroup．Thepatientsintheanteriorcervicalsurgicalgroupreceivedanteriorcervicaldecompressionandfusionsurger—Y，andtheposteriorcervicalsurgicalgroupreceivedposteriorcervicalopen—doorlaminoplasty．Theoperatingtime，intrao—perativeandpostoperativecomplications，excellentrateofspinal

6、cordandnervefunction，preoperativeandpostoperativeJapaneseorthopaedicsassociation(JOA)scoresofthetwogroupswereevaluated，respectively．ResultsThemeanop—erativetimeoftheanteriorcervicalsurgicalgroupwassignificantlysho~erthanthatoftheposteriorcervicalsurgicalgroup(P

7、ossoftheanteriorcervicalsurgicalgroupwassignificantlylessthanthatofposteriorcervi—calsurgicalgroup(P<0．01)．Therewasnosignificantdiferenceinexcellentratebetweenthetwogroups(P>0．05)．TherewasasignificantdifferenceinJOAscoresbetweenthetwogroupsafteroperation(P<0．05)；andpostoperativeJOAsc

8、oreofanterio