两种前路手术治疗邻近双节段脊髓型颈椎病的临床效果

Comparison of two anterior techniques in the surgical management of adjacent two-level cervical spondylotic myelopathy

中文关键词:  脊髓型颈椎病  椎间盘切除椎体次全切除术  椎间盘切除减压融合术

英文关键词:Cervical spondylotic myelopathy  Discectomy  Corpectomy  Discectomy and fusion

中文摘要:

  【摘要】 目的：比较双节段前路椎间盘切除减压融合术（anterior cervical discectomy and fusion，ACDF）和单节段前路椎体次全切除减压融合术（anterior cervical corpectomy and fusion，ACCF）对邻近双节段脊髓型颈椎病的治疗结果。方法：对2010年09月~2013年7月应用双节段椎间盘切除减压聚醚醚酮融合器（Polyetherether?鄄ketone cage，PEEK cage）植骨融合术及单节段椎体次全切减压钛网植骨融合术进行治疗的54例邻近双节段脊髓型颈椎病患者进行回顾性分析，ACCF组23例，ACDF组31例。比较两组患者基线资料、住院天数、手术时间、出血量、日本骨科协会（Japanese Orthopaedic Association，JOA）评分及疼痛视觉模拟评分（visual analogue score，VAS）的不同。通过测量术前、术后3d、末次随访时的影像学图片，分析两组患者颈椎曲度、融合节段高度及融合率的变化。结果：年龄、性别、病变节段、矢状位序列、植骨材料、住院天数和手术时间两组间差异无统计学意义，ACDF组的出血量显著少于ACCF组（175.4±12.1ml VS 201.3±80.4ml）。ACDF组JOA及VAS评分在术前（13.06±0.81、6.48±1.43）与末次随访时（15.45±1.06、2.97±1.28）比较均有显著统计学意义（P=0.000），ACCF组JOA及VAS评分同ACDF组，术后与术前比较均有统计学意义（P＜0.05）；但组间比较未发现明显差别（P＞0.05）。两组颈椎曲度和融合节段高度术后3d时较术前均有增加（P＜0.05），而末次随访时轻度下降（P＜0.05），ACDF组改善程度明显大于ACCF组（P＜0.05）。两组均获得了100%的融合率。结论：在邻近双节段脊髓型颈椎病的手术治疗中，ACDF出血量相对较少，能更好地改善颈椎曲度和维持融合节段高度。

英文摘要:

  【Abstract】 Objectives: To compare the outcome between double segments anterior cervical discectomy and fusion(ACDF) and anterior cervical corpectomy and fusion(ACCF) on the adjacent two segments in cervical spondylotic myelopathy. Methods: From September 2010 to July 2013, the application of two segments discectomy polyetheretherketone cages(PEEK cage) and bone grafting fusion and single segment corpectomy decompression and titanium mesh and bone graft for the treatment of 54 cases with adjacent two segments spondylotic myelopathy was analyzed retrospectively. Comparison of baseline data, length of hospital stay, operation time, amount of bleeding, Japanese Orthopaedic Association(JOA) scores and visual analogue scale(VAS) between two groups was performed. Analysis of two groups of cervical curvature, fusion segmental height and fusion rate of change at each follow-up time was conducted. Results: The fusion rate for two groups was 100%. The difference of age, gender, lesion segment, sagittal alignment, bone material, length of hospital stay and the operation time was not statistically significant, the amount of bleeding in group ACDF was significantly less than that in ACCF group(observation group, control group, 175.4+12.1ml VS 201.3+80.4ml). JOA and VAS score of two groups before surgery and at the final follow-up showed statistical significance(P=0.000), but there was no significant difference between two groups. Two groups had cervical curvature and height of the fused segment at 3 days after operation significantly increased compared with preoperation and final follow-up, that in ACDF group improved significantly than that in ACCF group(P＜0.05). Conclusions: For adjacent double segments cervical spondylotic myelopathy, ACDF has less blood loss, well improves the cervical curvature and maintains the height of the fused segment.