颈椎前路椎间融合术与人工椎间盘置换术联合椎间融合术治疗连续双节段颈椎病的中长期疗效对比

Anterior cervical discectomy and fusion vs combined with cervical artificial disc replacement in bi-level cervical disc degenerative disease: a mid- and long-term follow-up study

中文关键词:  颈椎病  双节段  椎间融合术  人工间盘置换  Hybrid手术  邻近节段退变  异位骨化

英文关键词:Cervical spondylosis  Bi-level  Spinal fusion  Cervical artificial disc replacement  Hybrid surgery  Adjacent segment degeneration  Heterotopic ossification

中文摘要:

  【摘要】 目的：比较前路颈椎椎间融合术（anterior cervical discectomy and fusion，ACDF）与颈前路人工椎间盘置换联合颈椎椎间融合（Hybrid手术）治疗连续双节段颈椎病的中长期疗效。方法：回顾性分析2007年1月~2012年3月在我科行ACDF及Hybrid手术治疗的连续双节段颈椎病患者，资料完整且随访时间＞60个月者共68例，其中ACDF 39例（ACDF组），Hybrid手术29例（Hybrid组），两组患者年龄、性别构成比、随访时间、手术节段等均无统计学差异。比较两组术前及末次随访时的JOA评分、颈椎功能障碍指数（NDI）、疼痛视觉模拟评分（VAS）、颈椎整体活动度、C2-C7颈椎曲度、相邻节段活动度、相邻节段退变情况等。结果：两组患者手术时间、出血量和术后引流量均无统计学差异；末次随访时的JOA、NDI及VAS评分均较同组术前有显著性改善（P<0.05），两组间同时间点比较均无统计学差异（P>0.05）。末次随访时根据Odom标准，Hybrid组的优良率为93.1%，ACDF组为92.3%，两组比较无统计学差异（P>0.05）；两组C2-C7曲度较术前均有所恢复，Hybrid组较ACDF组改善更好（P<0.05）；Hybrid组整体颈椎活动度及相邻节段活动度较术前无明显差异（P>0.05），ACDF组颈椎活动度较术前明显降低（P<0.05）、相邻节段活动度明显增加（P<0.05）；颈椎X线片评估相邻节段退变发生率无统计学差异（Hybrid组17.2% vs ACDF组20.5%，P>0.05）；末次随访时Hybrid组人工间盘置换节段异位骨化发生率为34.5%（10/29），其中Mobi-C假体发生率为41.2%（5/12），ProDisc-C假体发生率为29.4%（5/17）。结论：Hybrid手术治疗双节段颈椎病5年以上随访临床疗效及安全有效性与ACDF相当，但Hybrid手术可以更好地重建颈椎曲度，减少邻近节段代偿性活动的同时保持颈椎活动度。

英文摘要:

  【Abstract】 Objectives: To compare clinical and radiographic outcomes between anterior cervical discectomy and fusion(ACDF) and Hybrid surgery[ACDF combined cervical artificial disc replacement(C-ADR)] for bi-level cervical degenerative disease(cDDD) in the mid- and long-term follow-up. Methods: From January 2007 to March 2012, 68 patients with bi-level cDDD undergoing Hybrid surgery(n=29) and ACDF(n=39) were retrospectively reviewed. All patients were followed up for more than 60 months. The age, sex distribution, time of follow-up, surgical segments were not significantly different between the two groups. The neck disability index(NDI) scores, visual analogue scale(VAS), Japanese Orthopedic Association(JOA) scores, C2-C7 range of motion(ROM), C2-C7 lordosis, ROM of adjacent segments, and the degenerative changes of adjacent segments before surgery and at final follow-up, were recorded to assess the efficacy of the two methods. The heterotopic ossification(HO) was evaluated on lateral radiograph at final follow-up. Results: There was no statistical difference in operation time, blood loss or drainage volume between the two groups. At final follow-up, the scores of JOA scores, NDI, VAS improved significantly in all patients(P<0.05), but there was no significant difference between the two groups(P>0.05). In Odom′s scale, the excellent and good rate of the Hybrid patients was 93.1%, and that of the ACDF patients was 92.3%. The cervical lordosis(CL) was well restored in both groups, but Hybrid group had better recovery of CL than ACDF group. C2-C7 ROM decreased significantly in ACDF group. Hybrid group showed less decrease of C2-C7 ROM and less ROM of compensatory adjacent segments than ACDF group(P<0.05). No significant difference in radiographic degenerative changes at adjacent segments was found between the two groups(P>0.05). The incidence of HO in Hybrid group was 34.5%(10/29). Conclusions: The minimum five-year follow-up results show hybrid surgery can be considered an effective and safe alternative procedure compared with ACDF in bi-level cDDD. Hybrid surgery can maintain cervical ROM and lessen the ROM of compensatory adjacent segments.