软质内镜下颈前路椎间盘切除融合术与颈前路椎间盘切除融合术治疗双节段脊髓型颈椎病的短期疗效比较

Comparison of short-term efficacies between L-unitary soft endoscopic anterior cervical discectomy and fusion(LUSE-ACDF) and anterior cervical discectomy and fusion(ACDF) in the treatment of two-level cervical spondylotic myelopathy

中文关键词:  颈前路椎间盘切除融合术  双节段脊髓型颈椎病  软质脊柱内镜  临床疗效

英文关键词:Anterior cervical discectomy and fusion(ACDF)  Two-level cervical spondylotic myelopathy  Flexible spinal endoscopy  Clinical efficacy

中文摘要:

  【摘要】 目的：比较软质内镜下颈前路椎间盘切除融合术（L-unitary soft endoscopic anterior cervical discectomy and fusion，LUSE-ACDF）与颈前路椎间盘切除融合术（anterior cervical discectomy and fusion，ACDF）治疗双节段脊髓型颈椎病（cervical spondylotic myelopathy，CSM）的短期疗效。方法：对2024年1月~2025年3月辽宁省人民医院骨五科收治的48例双节段CSM患者进行回顾性分析。其中25例患者接受LUSE-ACDF，纳入LUSE-ACDF组（男13例，女12例，年龄57.7±10.2岁，病变节段：C3~C5节5例、C4~C6节段11例、C5~C7节段9例）；23例接受ACDF，纳入ACDF组（男13例，女10例，年龄59.7±8.4岁，病变节段：C3~C5节段5例、C4~C6节段10例、C5~C7节段8例）。两组患者一般资料如年龄、性别、体质指数（body mass index，BMI）等比较无显著性差异（P>0.05）。记录并比较两组患者术中出血量、手术时间、切口长度、住院时间及手术并发症。所有患者均获随访，随访时间6~12个月。评估并比较术前、术后1周、术后1个月及6个月时两组的颈部疼痛视觉模拟量表（visual analog scale，VAS）评分、日本骨科协会（Japanese Orthopaedic Association，JOA）评分及JOA评分改善率。结果：LUSE-ACDF组患者术中出血量比ACDF组少（41.32±7.33mL vs 60.78±11.62mL，P<0.05），手术时间比ACDF组长（110.40±9.22min vs 94.96±8.67min，P<0.05），手术切口长度比ACDF组短（3.04±0.22cm vs 3.44±0.27cm，P<0.05），住院时间比ACDF组短（8.68±1.25d vs 9.82±1.03d，P<0.05）。术后并发症方面，LUSE-ACDF组未出现相关并发症，ACDF组术后1例患者出现颈前方水肿、吞咽困难症状，经甘露醇等减轻水肿治疗后症状缓解。两组术后1周、1个月及6个月的颈痛VAS和JOA评分均较术前显著改善（P<0.05）。LUSE-ACDF组在术后1周及术后1个月时的颈痛VAS评分和JOA评分均优于ACDF组（P<0.05）。结论：LUSE-ACDF与ACDF均是治疗双节段CSM的有效术式。相较于ACDF，LUSE-ACDF具有术中出血少、切口小、住院时间短等微创优势，并能促进患者术后早期的疼痛缓解和神经功能恢复。尽管其远期疗效与开放手术相当，但在减少术后早期并发症（如吞咽困难）和改善短期生活质量方面展现出潜在价值。

英文摘要:

  【Abstract】 Objectives: To compare the short-term efficacy of L-unitary soft endoscopic anterior cervical discectomy and fusion(LUSE-ACDF) and anterior cervical discectomy and fusion(ACDF) in the treatment of two-level cervical spondylotic myelopathy(CSM). Methods: A retrospective analysis was conducted on 48 patients with two-level CSM treated in the Fifth Department of Orthopedics at Liaoning Provincial People′s Hospital from January 2024 to March 2025. Among them, 25 patients underwent LUSE-ACDF were included in the LUSE-ACDF group(13 males, 12 females, aged 57.7±10.2 years, affected segments: C3-C5 in 5 cases, C4-C6 in 11 cases, and C5-C7 in 9 cases), and 23 patients received ACDF were included in the ACDF group(13 males, 10 females, aged 59.7±8.4 years, affected segments: C3-C5 in 5 cases, C4-C6 in 10 cases, and C5-C7 in 8 cases). General patient data including age, sex, body mass index(BMI), and so on were comparable between the two groups(P>0.05). Intraoperative variables such as blood loss, operative time, incision length, hospital stay, and surgical complications were recorded and compared. All patients were followed up for 6 to 12 months. Follow-up evaluations were conducted preoperatively, at 1 week, 1 month, and 6 months postoperatively, using the visual analog scale(VAS) score for neck pain, Japanese Orthopaedic Association(JOA) scores, and JOA score improvement rate. Results: Compared with ACDF group, LUSE-ACDF group was significantly less in intraoperative blood loss(41.32±7.33mL vs 60.78±11.62mL, P<0.05), longer in the operative time(110.40±9.22min vs 94.96±8.67min, P<0.05), shorter in the incision length(3.04±0.22cm vs 3.44±0.27cm, P<0.05) and the length of hospital stay(8.68±1.25d vs 9.82±1.03d, P<0.05). In terms of postoperative complications, no relevant complications occurred in the LUSE-ACDF group; In the ACDF group, one patient developed anterior cervical edema and dysphagia, and the symptoms were relieved after treatment with mannitol to reduce edema. Both groups showed significant improvement in neck VAS and JOA scores at 1 week, 1 month, and 6 months postoperatively compared to preoperative values(P<0.05). The LUSE-ACDF group had significantly better neck VAS and JOA scores than the ACDF group at 1 week and 1 month postoperatively(P<0.05). Conclusions: Both LUSE-ACDF and ACDF are effective surgical procedures for the treatment of two-level CSM. Compared to ACDF, LUSE-ACDF offers minimally invasive advantages such as reduced intraoperative bleeding, smaller incisions, and shorter hospital stays, and it promotes early postoperative pain relief and neurological function recovery. Although its long-term efficacy is comparable to that of open surgery, it demonstrates potential value in reducing early postoperative complications(such as dysphagia) and improving short-term quality of life.