内镜下颈椎前路椎间盘切除融合术治疗单节段颈椎不稳的脊髓型颈椎病疗效分析

Efficacy of endoscopic anterior cervical discectomy and fusion in the treatment of cervical spondylotic myelopathy with single-segment cervical instability

中文关键词:  脊髓型颈椎病  颈椎不稳  脊柱内镜辅助  颈椎前路椎间盘切除融合术  疗效分析

英文关键词:Cervical spondylosis myelopathy  Spinal unstable  Spinal endoscopy assistance  Anterior cervical discectomy and bone graft fusion  Efficacy analysis

中文摘要:

  【摘要】　目的：探讨内镜下颈椎前路椎间盘切除融合术（endoscopic anterior cervical discectomy and fusion，Endo-ACDF）治疗伴单节段颈椎不稳的脊髓型颈椎病（cervical spondylotic myelopathy，CSM）的临床疗效。方法：回顾性分析2022年12月~2024年12月于我院接受手术治疗的42例伴单节段颈椎不稳的CSM患者的临床资料，其中20例采用Endo-ACDF，纳入观察组（男13例，女7例；年龄52.25±12.24岁）；22例采用传统开放ACDF，纳入对照组（男11例，女11例；年龄52.82±10.17岁）。所有患者术前均行动力位颈椎X线及MRI评估颈椎节段不稳及脊髓动态受压情况；比较两组患者围手术期指标（手术时间、术中出血量），术前与术后3、6、12个月的日本骨科协会（Japanese Orthopaedic Association，JOA）评分，颈肩疼痛视觉模拟量表（visual analogue scale，VAS）评分及C2-7 Cobb角变化，并记录并发症发生情况。结果：两组均顺利完成手术，观察组术中出血量显著性少于对照组（13.50±1.31mL vs 32.96±5.53mL，P<0.05），手术时间显著性长于对照组（120.65±3.23min vs 97.50±3.60min，P<0.05）。两组患者术后各时间点JOA评分和VAS评分均较术前显著性改善（P<0.05），但两组间同时间点的JOA评分、VAS评分及C2-7 Cobb角均无统计学差异（P>0.05）。观察组并发症发生率为5.00%（1/20），对照组为18.18%（4/22），观察组发生率更低，但差异无统计学意义（P>0.05）。结论：对于单节段颈椎不稳的CSM患者，Endo-ACDF在实现与开放手术相当的神经功能改善和曲度恢复的同时，具有出血少、并发症发生率相对更低的优势。

英文摘要:

  【Abstract】 Objectives: To explore the clinical efficacy of endoscopic anterior cervical discectomy and fusion(Endo-ACDF) in the treatment of cervical spondylotic myelopathy(CSM) complicated with cervical instability. Methods: A retrospective analysis was conducted on the clinical data of 42 patients with single-segment cervical instability combined with CSM, who were diagnosed via dynamic cervical X-ray and MRI and underwent surgical treatment in our hospital from December 2022 to December 2024. Among the patients, 20 cases treated with Endo-ACDF were enrolled in the observation group(13 males and 7 females; mean age: 52.25±12.24 years old), and 22 patients treated with conventional open ACDF were included in the control group(11 males and 11 females; mean age: 52.82±10.17 years old). Preoperatively, all patients received dynamic cervical X-ray and MRI examinations to evaluate segmental instability and dynamic spinal cord compression. Perioperative indicators(operation time, intraoperative blood loss), Japanese Orthopaedic Association(JOA) scores, visual analogue scale(VAS) scores for shoulder and neck, and changes in the C2-7 Cobb angle before operation as well as at 3, 6 and 12 months after operation were compared between the two groups. The incidence of complications was also recorded. Results: Operations were successfully completed in both groups. The observation group was significantly less in intraoperative blood loss(13.50±1.31mL vs 32.96±5.53mL, P<0.05), while longer in operation time(120.65±3.23min vs 97.50±3.60min, P<0.05) than the control group. The JOA scores and VAS scores of both groups at each postoperative time point were significantly improved compared with those before operation(P<0.05). There were no statistically significant differences in JOA scores, VAS scores and C2-7 Cobb angle between the two groups at the same time point(P>0.05). The complication rate of the observation group was 5.00%(1/20), which was obviously lower than 18.18%(4/22) of the control group, without statistical difference(P>0.05). Conclusions: For CSM patients with single-segment cervical instability, Endo-ACDF can achieve equivalent neurological function improvement and cervical curvature restoration as open surgery. Meanwhile, it presents minimally invasive advantages including less intraoperative blood loss and a relatively lower complication rate.