颈后路全椎板切除减压治疗颈椎脊髓损伤的临床疗效分析

目的 比较颈后路全椎板切除与颈前路椎体次全切除减压治疗颈椎脊髓损伤疗效差异。方法 选取89例重度颈椎脊髓损伤患者为研究对象，术前患者均出现了完全性瘫痪或不完全性瘫痪症状。按照手术方案将其分为后路组（43例）与前路组（46例），后路组行后路全椎板切除减压内固定术，前路组行前路椎体次全切除减压内固定术，比较两组术中出血量、手术时间及术后引流量、并发症差异，分析术前、术后2周时两组呼吸模式及术后3、6周时两组痰培养病原体差异；采用ASIA评分评价术前，术后2周、2年评价神经功能状况。对比分析两组术后2年植骨融合率的差异。结果 后路组（n=43）及前路组（n=46）术中出血量及术后引流量差异有统计学意义（P＜0.05），手术时间差异无统计学意义（P>0.05）；前路组术后出现1例血肿，3例脑脊液漏；后路组出现了2例脑脊液漏，1例深静脉血栓。后路组及前路组术前的腹式呼吸、胸腹联合呼吸的患者例数差异无统计学意义（P>0.05），但术后2周时两组不同呼吸模式例数差异有统计学意义（P＜0.05）；术后3周痰培养阳性的普通细菌和真菌例数差异无统计学意义（P>0.05）；术后6周，后路组痰培养无论是普通细菌还是真菌阳性例数都减少，而对照组均有少量增加，两者例数构成比差异有统计学意义（P＜0.05），术前及术后随访评价患者神经功能ASIA评分，前路组与后路组组内术后2年患者神经功能评分均明显高于术前，ASIA评分差异有统计学意义（P<0.05）。前路组与后路组运动及感觉评分的组间差异无统计学意义（P>0.05）。前路组与后路组完全性瘫痪（A级）、不完全性瘫痪（B级）在术前及术后2年的随访差异无统计学意义（P>0.05）。两组术后2年植骨融合率差异无统计学意义（P>0.05）。结论 颈后路全椎板切除减压较前路椎体次全切除减压术后2年神经功能恢复无差异，但后路全椎板切除更有利于呼吸功能恢复和肺部感染的控制。
Objective To compare the surgical outcome of anterior corpectomy decompression and posterior extensive laminectomy and lateral mass fixation in treatment of cervical spinal cord injury. Methods Eighty-nine patients with severe cervical spinal cord injury were enrolled in the study, of whom 46 cases were treated with anterior corpectomy and fusion and 43 cases were treated with posterior extensive laminectomy and lateral mass fixation. The intraoperative blood loss, postoperative drainage, and operation time were compared between two groups. The complications were recorded in two groups. The breath mode was compared two weeks after operation between anterior and posterior group. The positive result of sputum culture between two groups 3 and 6 weeks after operation was compared. ASIA score was used to evaluate neurological function before and 2 weeks and 2 year after operation. The bone fusion ration was compared 2 years after operation. Results There was significant difference in the volume of intraoperative blood loss and postoperative drainage between two groups（P＜0.05）; while there was no significant difference in operation time between two groups （P>0.05）. There was one case of hematoma, and 3 cases of cerebrospinal fluid leakage in the anterior group; while there was 1 case of infection, 1 case of deep venous thrombosis and 2 cases of cerebrospinal fluid leakage in the posterior group. There was significant difference in the breathe mode between two groups 2 weeks after operation（P＜0.05）, but no significant difference before operation (P>0.05). There was statistical difference in sputum culture between two groups 6 weeks after operation（P＜0.05）, but not at 3 weeks after operation（P>0.05）. There was no significant