三种颈前路减压术式治疗多节段脊髓型颈椎病的并发症比较

Comparative analysis of complications of different anterior decompression procedures for treating multilevel cervical spondylotic myelopathy

中文关键词:  颈前路减压  多节段脊髓型颈椎病  并发症

英文关键词:Anterior decompression  Multilevel cervical spondylotic myelopathy  Complications

中文摘要:

  【摘要】 目的：分析比较不同颈前路减压术式治疗多节段脊髓型颈椎病术后并发症的差异。方法：回顾性分析2006年1月～2011年8月手术治疗的327例三节段脊髓型颈椎病患者的临床资料，根据手术方式不同分为三组：前路椎间盘切除减压融合术（anterior cervical discectomy with fusion, ACDF）（A组）、前路椎体切除减压融合术（anterior cervical corpectomy with fusion, ACCF）（B组）和ACDF+ACCF“混合式”减压术（C组），其中A组男性69例，女性55例，平均年龄53.48±8.50岁；B组男性51例，女性43例，平均年龄54.36±7.82岁；C组男性61例，女性48例，平均年龄53.68±7.80岁，组间比较无统计学差异。对三种不同手术方式并发症情况进行比较。结果：平均随访时间3.5年（1.5～5年）。共有69例在手术后出现多种并发症，包括植骨未融合11例，其中C组3例（2.75％），B组8例（8.51％），B组植骨不愈合发生率显著高于A组和C组（P＜0.05）；声音嘶哑12例，其中A组5例（4.03%），B组3例（3.19%），C组4例（3.67%）；吞咽困难26例，其中A组11例（8.87%），B组7例（7.45%），C组8例（7.34%）；C5神经根麻痹12例，其中A组2例（1.61%），B组5例（5.32%），C组5例（4.59%）；脑脊液漏5例，其中A组3例，C组2例；切口感染3例，其中B组2例，C组1例。A组患者并发症发生率为16.94%，B组为26.60%，C组为21.10%，B组患者术后并发症的发生率显著高于其余两组（P<0.05）。结论：多节段脊髓型颈椎病患者手术治疗中，ACDF的并发症发生率最低，ACCF术式应慎用，其并发症的发生率较高。

英文摘要:

  【Abstract】 Objectives: Comparative analysis of complications of different anterior decompression procedures for treating multilevel cervical spondylotic myelopathy(CSM). Methods: This study retrospectively reviewed the postoperative complications in 327 patients with three-level CSM in whom the anterior cervical surgery was performed between January 2006 and August 2011. According to the decompression procedure, patients were divided into three groups: multilevel anterior cervical discectomy with fusion(ACDF) group(group A), multilevel anterior cervical corpectomy with fusion(ACCF) group(group B), hybride decompression technique (ACDF+ACCF)(group C). There were 69 males and 55 females in group A with an average age of 53.48±8.50 years old, 51 males and 43 females in group B with an average age of 54.36±7.82 years old, and 61 males and 48 females in group C with an average age of 53.68±7.80 years old. No significant differences were found among three groups. The differences of the complications among these groups were compared. Results: The average follow-up time was 3.5 years(ranging from 1.5 to 5 years). There were 69 patients who developed complications after surgery. The complications including graft migration, collapse or displacement, hoarseness, dysphagia, C5 palsy, cerebral fluid leakage and wound infection during the follow-up. 11 patients were observed graft migration and non-union during the follow-up, 3 patients(2.75%) in group C and 8 patients(8.51%) in group B. Patients in group B had significantly higher rate of non-union than patients in group A and C(P<0.05). Postoperative hoarseness was observed in 12 patients, 5(4.03%) of these patients were in group A, 3(3.19%) patients were in group B and the other 4(3.67%) patients were in group C. Postoperative dysphagia appeared in 26 patients, 11(8.87%) of them were in group A, 7(7.45%) of them were in group B and the other 8(7.34%) patients were in group C. 12 patients had C5 palsy after operation, 2(1.61%) of these patients were in group A, 5(5.32%) of these patients were in group B and the other 5(4.59%) patients were in group C. 3 patients in group A and 2 patients in group C had cerebral fluid leakage. 3 patients experienced wound infection(2 in group B and 1 in group C). The rate of complications was 16.94% in group A, 26.60% in group B and 21.10% in group C. Patients in group B had significantly higher rate of complications than the other two groups(P<0.05). Conclusions:　The multilevel ACDF approach has the lowest rate of non-union, long corpectomy approach should be selected prudently because of high rate of complications.