颈前路减压融合内固定治疗双节段脊髓型颈椎病术后轴性症状分析

Axial symptoms after anterior cervical decompression and fusion for two-level cervical spondylotic myelopathy

中文关键词:  脊髓型颈椎病  前路手术  轴性症状

英文关键词:Cervical spondylotic myelopathy  Anterior surgery  Axial symptom

中文摘要:

  【摘要】 目的：分析颈前路椎体次全切除融合内固定与颈前路双节段椎间盘摘除融合内固定治疗双节段脊髓型颈椎病术后轴性症状（AS）的发生情况。方法：2004年3月～2007年5月113例双节段脊髓型颈椎病患者分别行颈前路椎体次全切除融合内固定（A组，61例）和颈前路双节段椎间盘摘除融合内固定（B组，52例）。观察两组患者术前和末次随访时的JOA评分、融合节段高度和矢状面Cobb角，计算每组的神经功能改善率，统计每组术后颈部AS的发生率。结果：随访24~48个月，平均32.2个月。末次随访时A、B组神经功能改善率分别为（70.1±12.2）%、（63.5±4.7）%，无统计学差异（P>0.05）；融合节段高度变化值分别为-0.04±0.02cm、0.05±0.02cm，有统计学差异（P<0.05）；融合节段后凸率分别为34.4%、13.5%，有统计学差异（P<0.05）；颈部AS发生率分别为45.9%（28/61）、26.9%（14/52），有统计学差异（P<0.05）。末次随访时融合节段高度降低者颈部AS发生率较高度增大者高（P<0.05），A组中融合节段高度降低者的比例数明显大于B组（P<0.05）。末次随访时，A组中融合节段明显后凸者的颈部AS发生率明显高于无后凸或轻度后凸者（P<0.05），A组中融合节段明显后凸者的比例数明显大于B组（P<0.05）。结论：颈前路减压融合内固定术后融合节段高度降低和明显后凸的患者AS发生率较高。与颈前路椎体次全切除融合内固定术相比，颈前路双节段椎间盘摘除融合内固定术治疗颈椎病在取得良好临床疗效的同时减少了术后颈部AS的发生。

英文摘要:

  【Abstracts】 Objective：To investigate the incidence of axial symptoms（AS） after anterior cervical corpectomy and fusion（ACCF） and anterior cervical discectomy and fusion（ACDF） for 2-level cervical spondylotic myelopathy（CSM） respectively.Method：From March 2004 to May 2007，the clinical and radiographic data of 113 CSM patients with 2-level involvement treated surgically were collected，there were 61 cases（42 males and 19 females） with the mean age of 56.2 years（range，36-73 years） undergoing ACCF（group A），while 52（37 males and 15 females） with the mean age of 54.6 years（range，33-77 years） underwent 2-level ACDF（group B）.The pre- and post-operative Japanese Orthopedic Association scores，segmental height and segmental lordosis were compared between each group.And the incidence of postoperative AS was analyzed either.Result：All patients were followed up for an average of 32.2 months（range，24-48months）.The improving rate of neurological function at final follow-up was （70.1±12.2）% and （63.5±4.7）% for group A and B respectively，with no significant difference（P>0.05）.However the change of fusion segments height was -0.04±0.02cm and 0.05±0.02cm，with significant difference（P<0.05）.Kyphosis rate for fusion segments was 34.4% and 13.5%，with significant difference（P<0.05）.The incidence of AS at final follow-up was 45.9%（28/61） and 26.9%（14/52） for group A and B respectively，with significant difference（P<0.05）.The prevalence of AS complicated with lowering of fusion segments height was higher than that with no lowering of fusion segments height（P<0.05），and the lowering of fusion segments height in group A was higher than that in group B（P<0.05）.The prevalence of AS complicated with severe kyphosis in group A was higher than that with no or mild kyphosis（P<0.05），and the prevalence of severe kyphosis in fusion segments in group A was higher than that in group B（P<0.05）.Conclusion：The incidence of the postoperative AS is much higher in patients complicated with decreased fusion segments height and/or with obvious kyphosis after anterior cervical decompression and fusion.Compared with ACCF，ACDF for CSM is associated with good outcomes and lower incidence of the postoperative AS.