Conservative treatment versus surgery in spondylotic cervical myelopathy:: a prospective randomised study
Conservative treatment versus surgery in spondylotic cervical myelopathy:: a prospective randomised study
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DOI：
10.1007/s005860000132
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发表时间：
2000-12-01
影响因子：
2.8
通讯作者：
Urbánek, I
中科院分区：
文献类型：
--
作者：
Kadanka, Z;Bednarík, J;Urbánek, I
进行了一项为期2年的前瞻性随机研究，比较轻度和中度脊髓型颈椎病（SCM）的保守治疗和手术治疗。48例表现为SCM临床综合征的患者，mJOA评分≥12分，随机分为两组。A组保守治疗27例，平均年龄55.6 +/- 8.6岁；B组手术治疗21例，平均年龄52.7 +/- 8.1岁。临床结果通过mJOA评分、恢复率（RR）、10米步行时间、日常活动评分（通过视频记录并由两名不了解治疗的观察者评估）以及患者在随访6、12和24个月时的主观评估来衡量。在2年的随访中，两组患者的mJOA评分、康复率或10米步行时间均无明显恶化。在手术组中，日常活动和主观评价的得分略有下降。两组比较，mJOA评分和量化步态随时间的变化无显著差异，但24个月时视频记录的日常活动评分差异显著，手术组略低，RR和主观评价评分差异显著，手术组在12个月和24个月时均较差。然而，在第6个月，手术组的最后一个参数明显优于保守组。在本研究设计中，轻中度SCM的手术治疗，包括没有或非常缓慢，潜伏的进展和症状持续时间相对较长的患者，在2年的随访中没有显示出比保守治疗更好的结果。
A prospective randomised 2-year study was performed to compare the conservative and operative treatment of mild and moderate forms of spondylotic cervical myelopathy (SCM). Forty-eight patients presenting with the clinical syndrome of SCM, with a modified Japanese Orthopaedic Association (mJOA) score of 12 points or more, were randomised into two groups. Group A, treated conservatively, consisted of 27 patients, mean age 55.6 +/- 8.6 years, while group B was treated surgically (21 patients, mean age 52.7 +/- 8.1 years). The clinical outcome was measured by the mJOA score, recovery rate (RR), timed 10 m walk, score of daily activities (recorded by video and evaluated by two observers blinded to the therapy), and by the subjective assessment of the patients at 6, 12, and 24 months of the follow-up. There was, on average, no significant deterioration in mJOA score, recovery ratio, or timed 10 m walk within either group during the 2 years of follow-up. In the surgery group there was a slight decline in the scores for daily activities and subjective evaluation. A comparison of the two groups showed no significant differences in changes over time in mJOA score or quantified gait, but there were significant differences in the score of daily activities recorded by video at 24 months, which was a little lower in the surgical group, and also in RR and subjective evaluation, which were both worse in the surgical group at months 12 and 24. However, at month 6, this last parameter was significantly better in the surgical than in conservative group. Surgical treatment of mild and moderate forms of SCM in the present study design, comprising the patients with no or very slow, insidious progression and a relatively long duration of symptoms, did not show better results than conservative treatment over the 2-year follow-up.