颈椎减压手术治疗合并肌萎缩侧索硬化症的脊髓型颈椎病疗效观察

Clinical efficacy of cervical decompression surgery in the treatment of cervical spondylotic myelopathy complicated with amyotrophic lateral sclerosis

中文关键词:  脊髓型颈椎病  肌萎缩侧索硬化症  合并症  颈椎减压手术  疗效

英文关键词:Cervical spondylotic myelopathy  Amyotrophic lateral sclerosis  Comorbidity  Cervical decompressive surgery  Treatment outcome

中文摘要:

  【摘要】 目的：探讨合并肌萎缩侧索硬化症（amyotrophic lateral sclerosis，ALS）的脊髓型颈椎病（cervical spondylotic myelopathy，CSM）患者接受颈椎减压手术后的功能结局、生存情况。方法：回顾性分析在我院确诊为合并ALS的CSM并接受颈椎手术的22例患者，男19例，女3例；年龄44~76岁（58.7±9.1岁）。在术前与末次随访时采用疼痛视觉模拟量表（visual analog scale，VAS）评分、颈椎功能障碍指数（neck disability index，NDI）、改良日本骨科学会（modified Japanese Orthopaedic Association，mJOA）评分、SF-36量表（36-item short-form health survey）以及ALS功能量表修订版（amyotrophic lateral sclerosis functional rating scale-revised，ALSFRS-R）评估神经功能和生活质量，计算ALSFRS-R月下降率（ΔFS）；采用Kaplan-Meier法进行生存分析。结果：22例患者均顺利完成手术，围手术期未发生严重并发症。随访2~18个月（5.2±3.5个月）。随访期间患者整体表现为功能持续恶化，VAS评分由2.0（0.0, 3.0）升至5.0（3.0, 7.0）（P<0.01），NDI由7.86±6.55升至18.50±11.16（P<0.01）；mJOA由12.41±1.89降至10.43±2.34（P<0.01），仅2例（9.1%）患者出现轻度改善。ALSFRS-R总分由42.47±4.46降至37.63±10.10，球部、精细运动及粗大运动功能均显著下降（P<0.01），呼吸功能变化无统计学意义（P=0.08）。ΔFS为0.70±0.45分/月。SF-36量表多个维度评分下降，尤以躯体疼痛、活力及心理健康下降最为明显。Kaplan-Meier生存分析显示随访期间共5例死亡（22.7%），12个月估计生存率约82%，18个月约48%，总体生存趋势与ALS自然病程相一致。结论：CSM合并ALS患者行颈椎减压手术未能改变ALS的自然病程，患者术后总体仍呈神经功能及生活质量持续下降趋势。

英文摘要:

  【Abstract】 Objectives: To investigate the functional outcomes and survival of cervical decompression surgery in patients with cervical spondylotic myelopathy(CSM) complicated with amyotrophic lateral sclerosis(ALS). Methods: A retrospective cohort study was conducted on 22 patients(19 males, 3 females; aged 44-76 years, mean 58.7±9.1 years) diagnosed with both CSM and ALS who underwent cervical decompression surgery at our institution. Neurological functional status and quality of life were assessed preoperatively and at final follow-up using the visual analog scale(VAS), neck disability index(NDI), modified Japanese Orthopaedic Association(mJOA) scale, 36-item short-form health survey(SF-36), and ALS functional rating scale-revised(ALSFRS-R). The monthly decline rate of ALSFRS-R(ΔFS) was calculated. Overall survival was evaluated using Kaplan-Meier survival analysis. Results: All patients successfully underwent cervical surgery without major perioperative complications. The follow-up duration ranged from 2 to 18 months(5.2±3.5 months). During follow-up, most patients exhibited progressive functional deterioration. VAS score increased from 2.0(0.0, 3.0) to 2.0（0.0, 3.0） and NDI from 7.86±6.55 to 18.50±11.16(both P<0.01). The mJOA score declined from 12.41±1.89 to 10.43±2.34(P<0.01), with only two patients(9.1%) showing slight improvement. The ALSFRS-R total score decreased from 42.47±4.46 to 37.63±10.10, with significant declines in bulbar, fine motor, and gross motor subscores(all P<0.01), while respiratory function showed no significant change(P=0.08). The mean ΔFS was 0.70±0.45 points per month. SF-36 scores declined across several domains, particularly bodily pain, vitality, and mental health. Kaplan-Meier analysis demonstrated five deaths(22.7%) during follow-up, with an estimated survival rate of approximately 82% at 12 months and 48% at 18 months, consistent with previously reported survival patterns and natural progression of ALS. Conclusions: In patients with coexisting CSM and ALS, cervical decompression surgery cannot alter the natural course of ALS and is associated with continued decline in neurological function and quality of life.