跳跃式颈前路椎间盘切除植骨融合术治疗多节段颈椎病的疗效分析

Department of orthopedics, Peking University Third Hospital, Beijing, 100191, China

中文关键词:  前路椎间盘切除手术  颈椎病  疗效

英文关键词:Anterior cervical discectomy and fusion  Cervical spondylosis  Outcome

中文摘要:

  【摘要】 目的：评估跳跃式颈前路椎间盘切除植骨融合手术治疗节段跳跃式的颈椎间盘突出所致颈椎病的近期临床疗效及影像学变化。方法：回顾性分析我院2010年3月~2015年12月因跳跃式椎间盘突出导致颈椎病行跳跃式颈前路椎间盘切除植骨融合（ACDF）手术患者（A组），男性14例，女性4例，年龄37~67岁，平均52.2±10.1岁。取同期行连续ACDF手术的20例患者作为对照（B组），男性16例，女性4例，年龄40~68岁，平均51.6±9.5岁。比较两组患者手术时间、出血量、并发症、术前、术后3个月及末次随访的JOA评分、C2-C7整体活动度（ROM）、C2-C7矢状位垂直轴距离（SVA）、T1倾斜角（T1 slope）、植骨融合率、邻近椎间盘退变情况等结果。结果：所有38例患者术后均获随访，随访中位数时间为12个月（6~36个月），两组间无统计学差异（P＞0.05）。A组患者手术时间（71.7±9.2min）、手术出血量（17.8±7.3ml）均显著小于B组（111.5±36.1min、47.0±19.1ml，P＜0.05）。两组患者术后1周、术后3个月及末次随访时JOA评分均较术前有显著改善（P＜0.05），各时间点两组间JOA评分比较均无显著差异。末次随访时两组患者JOA评分改善优良率分别为94.4%与97.2%。A组患者的C2-C7 ROM从术前的50.0°±7.1°显著下降到术后3个月的38.0°±6.1°和末次随访时的44.3°±5.7°（P＜0.05），B组患者的C2-C7 ROM从术前的51.8°±10.6°显著下降到术后3个月的38.0°±9.4°和末次随访时的43.9°±10.5°（P＜0.05），两组之间比较差异无统计学意义。A组患者术后3个月C2-C7 SVA（26.8±2.0mm）相比术前（24.2±2.0mm）有显著升高（P＜0.05），而末次随访时C2-C7 SVA（24.5±2.2mm）与术前相比差异无统计学意义。B组患者的C2-C7 SVA从术前的23.8±1.4mm明显升高到术后3个月的26.5±1.8mm和末次随访时的24.3±1.5mm（P＜0.05）。两组之间C2-C7 SVA比较差异无统计学意义。A组患者的T1 slope从术前的28.1°±3.2°明显升高到术后3个月的31.4°±3.0°和末次随访时的30.0°±3.1°（P＜0.05），B组患者的T1 slope从术前的28.3°±2.1°明显升高到术后3个月的31.6°±2.3°和末次随访时的30.3°±2.1°（P＜0.05）。两组之间T1 slope比较差异无统计学意义（P>0.05）。末次随访时，A组邻近节段椎间盘退变加重率为16.7%（6/36），保留节段椎间盘退变加重率为14.3%（3/21），B组邻近节段椎间盘退变加重率为20.0%（8/40），均未出现相关临床症状。两组间无统计学差异。结论：跳跃式ACDF术式的近期临床疗效良好，与连续ACDF术式近期临床疗效及影像学变化基本一致。

英文摘要:

  【Abstract】 Objectives: To investigate the early clinical and radiological outcomes of skip-level ACDF in the treatment of noncontiguous levels of cervical spondylosis. Methods: The clinical data of 18 patients including 14 males and 4 males with a mean age of 52.2±10.1 years(ranged from 37 to 67) who underwent skip-level ACDF (group A) and 20 patients including 16 males and 4 males with a mean age of 51.6±9.5 years (ranged from 40 to 68) who underwent contiguous ACDF (group B) in our hospital from March 2010 to December 2015 were retrospectively studied. The operation time, intraoperative blood loss, postoperative complications, JOA scores, C2-7 SVA and T1 slope obtained from Sagittal reconstruction CT images were evaluated. The C2-7 range of motion(ROM) was determined by using dynamic X-ray which was obtained in standing position before surgery and at routine postoperative intervals. The adjacent segment disc degeneration was verified according to Miyazaki classification. Results: All 38 patients received postoperative follow-up with a median time of 12 months (ranged from 6 months to 36 months), with no remarkable difference between the two groups. The average operation time(71.7±9.2min) and intraoperative blood loss(17.8±7.3ml) of group A were significantly lower than those (111.5±36.1min and 47.0±19.1ml) of group B(P＜0.05). Both of the two groups had significant improvement after operation in JOA scores(P＜0.05). But there was no significant difference in JOA score between the two groups. The mean C2-7 ROM of group A decreased from 50.0°±7.1° to 38.0°±6.1° after 3 months and back to 44.3°±5.7° at final follow-up(P＜0.05). The mean C2-7 ROM of group B decreased from 51.8°±10.6° to 38.0°±9.4° after 3 months and then increased to 43.9°±10.5° at final follow-up(P＜0.05) with no significant difference between the two groups. The postoperative mean C2-7 SVA of group A remarkably increased from 24.2±2.0mm to 26.8±2.0mm after 3 months and showed no significant difference at final follow-up(24.5±2.2mm). The postoperative mean C2-7 SVA of group B significantly increased from 23.8±1.4mm to 26.5±1.8mm after 3 months and 24.3±1.5mm at final follow-up(P＜0.05). No significant difference of postoperative mean C2-7 SVA between the two groups was found. The mean T1 slope of group A increased from 28.1°±3.2° to 31.4°±3.0° after 3 months and 30.0°±3.1° at final follow-up(P＜0.05). The mean T1 slope of group B increased from 28.3°±2.1° to 31.6°±2.3° after 3 months and 30.3°±2.1° at final follow-up(P＜0.05) with no significant difference when compared with group A. The rate of adjacent segment disc degeneration was 16.7%(6/36) in group A and 20.0%(8/40) in group B respectively without clinical symptom. The rate of skip-level segment disc degeneration was 14.3%(3/21) in group A. No significant difference of the fusion rate existed between the two groups. Conclusions: Skip-level ACDF presents good early clinical and radiological outcomes, with no significant difference comparing to contiguous ACDF.