摘要目的：通过回顾性病例分析，评价单开门椎板成形联合椎间孔切开术(laminoplasty with foraminotomy, LF )与前路椎间盘切除减压融合术（anterior cervical discectomy and fusion，ACDF）治疗脊髓神经根型颈椎病的临床及影像学疗效。方法自2008年1月至2010年1月，按照纳入及排除标准选取68例患者纳入研究，ACDF组33例，LF组35例，随访均超过2年。疗效评估采用日本骨科协会（Japanese Orthopedic Association，JOA）评分及改善率，影像学评估采用X线片测量颈椎曲度和颈椎活动度（range of motion, ROM），末次随访时采用颈椎功能障碍指数量表（neck disabilitv index，NDI）评估两组患者颈肩部疼痛的改善程度。结果 ACDF组手术时间平均187 min、出血量平均为127 ml，与LF组（154 min、235 ml）比较，差异均有统计学意义（t手术时间=4.170，P=0.000；Z出血量=-6.888，P=0.000）。术后两组下肢感觉改善率（ACDF组64.0%、LF组66.0%）的差异有统计学意义（Z=-7.512，P=0.000），而上肢运动、上肢感觉及下肢运动改善率的差异均无统计学意义。术后3个月时ACDF组出现1例植骨不融合，随访2年时3例出现邻近节段退变；而LF组未见并发症出现。末次随访时ACDF组在提物（Z=-3.947, P=0.000）及开车（t=-7.523，P=0.000）方面的NDI疼痛评分低于LF组。ACDF组颈椎曲度由术前平均13.7°增加至16.2°，而LF组由14.6°降至13.3°（Z=-3.374，P=0.001）。两种术式均导致术后颈椎ROM下降（ACDF组14.8°、LF组16.5°），但差异有统计学意义（t=-2.167，P=0.034）。结论 LF在改善长节段颈椎间盘突出所致的颈椎髓性症状及根性症状方面与ACDF的临床效果相近，但具有手术时间短、手术技术相对简单、近期并发症发生率低等优势，是治疗混合型颈椎病安全、有效的手术方式。

abstractsObjective To assess the clinical and radiologic outcomes between laminoplasty with forominotomy(LF) and anterior cervical discectomy and fusion(ACDF) in treating cervical radiculomyelopathy(CRM). Methods Datas of 68 patients (ACDF=33, LF=35) from January 2008 to January 2010 was collected retrospectively, the follow-up is at least 2 years. The Japa-nese Orthopedic Association (JOA) score and associated recovery rate were evaluated. For radiographic evaluation, the lordotic an-gle and range of motion (ROM) at C2-C7 were investigated. The Neck Disabilitv Index Scale(NDI) was used to evaluate the degree of patient’pain at the last follow-up. Results Patients’demographics were similar between the two groups. The differences be-tween ACDF and LF in operative time (187min VS 154min),the blood loss (127 ml VS 235 ml) and the sensation of lower extremity (64.0%VS 66.0%) are significant(t=4.170, P=0.000;Z=-6.888, P=0.000;Z=-7.512, P=0.000). 1 case with failed fusion of bone graft 3 months post-operation. 3 cases of adjacent segment degenerative changes occurred at the 2nd year follow-up in ACDF group. But no such complications occurred in the EOLF group. In addition, ACDF group showed lower NDI score than LF group in extracting and amusing (Z=-3.947, P=0.000;t=-7. 523, P=0.000). Cervical lordosis of ACDF increased from 13.7° to 16.2°, while that of LF group decreased from 14.6° to 13.3°(Z=-3.374,P=0.001);Both of the two groups (ACDF/LF) exhibited decreased cervi-cal ROM (14.8° VS 16.5°, t=-2.167, P=0.034). Conclusion The two surgical procedures have similar clinical effects in treating multi-segmental CRM. However, the LF group demonstrated shorter operative time, fewer short-term complications, so it proved to be effective and safe surgical procedure.