ACDF治疗单节段脊髓型颈椎病合并发育性颈椎管狭窄临床疗效分析

Clinical outcomes of ACDF in single-segment cervical spondylotic myelopathy with developmental cervical spinal canal stenosis

中文关键词:  椎间盘切除植骨融合内固定术  脊髓型颈椎病  发育性颈椎管狭窄

英文关键词:Anterior cervical discectomy and fusion  Cervical spondylotic myelopathy  Developmental cervical spinal canal stenosis

中文摘要:

  【摘要】 目的：探讨颈椎前路椎间盘切除植骨融合内固定术（anterior cervical discectomy and fusion，ACDF）治疗单节段脊髓型颈椎病（cervical spondylotic myelopathy，CSM）合并发育性颈椎管狭窄（developmental cervical spinal canal stenosis，DCS）的临床疗效。方法：回顾性分析2015年6月~2017年6月我院采用ACDF治疗单节段CSM患者66例。根据颈椎侧位X线片是否存在连续3个节段的椎管矢状径/椎体矢状径＜0．75，分为发育性颈椎管狭窄组（developmental cervical spinal canal stenosis group，DCS）组（30例），其余纳入非发育性颈椎管狭窄组（non-developmental cervical spinal canal stenosis group，NDCS）组（36例）。其中DCS组男性21例、女性9例，年龄48.4±10.1岁；NDCS组男性23例、女性13例，年龄48.8±7.3岁，两组性别、年龄差异无统计学意义（P＞0.05）。DCS组随访39.0±2.1个月，NDCS组随访39.2±1.9个月，两组随访时间差异无统计学意义（P＞0.05）。记录两组患者围手术期并发症情况。比较两组患者术前、术后3个月、术后1年及末次随访时颈椎功能障碍指数（neck disabilitv index，NDI）、日本骨科协会（Japanese Orthopaedic Association，JOA）评分，并在颈椎侧位X线片上测量颈椎曲度（C2~C7 Cobb角）及融合节段椎间隙高度，观察植骨融合情况及对比两组患者末次随访时JOA评分改善优良率。结果：患者手术顺利，术后出现吞咽困难3例（DCS组1例，NDCS组2例），对症治疗1周后症状消失。DCS组手术时间78.2±10.4min、术中出血量32.3±5.1ml；NDCS组手术时间76.7±10.7min、术中出血量30.5±5.5ml。两组手术时间、术中出血量差异均无统计学意义（P＞0.05）。DCS组JOA评分术前为7.63±1.50分，术后3个月为12.73±1.41分，术后1年为13.83±1.58分，末次随访时为15.03±1.73分；NDI术前为（38.42±5.90）%，术后3个月为（19.89±2.25）%，术后1年为（13.67±2.99）%，末次随访时为（4.83±3.66）%。NDCS组JOA评分术前为8.08±1.86分，术后3个月为12.97±1.70分，术后1年为13.97±1.59分，末次随访时为15.06±1.47分；NDI术前为（36.26±6.63）%，术后3个月为（19.96±3.05）%，术后1年为（14.61±2.75）%，末次随访时为（5.69±2.76）%。两组术后的JOA评分、NDI均较术前明显改善（P＜0.05），相同时间节点组间比较差异无统计学意义（P＞0.05）。DCS组颈椎曲度术前为11.27°±5.56°，术后3个月为14.80°±5.53°，术后1年为14.97°±5.11°，末次随访时为15.64°±4.86°；融合节段椎间高度术前为5.71±1.47mm，术后3个月为7.56±1.43mm，术后1年为7.07±1.84mm，末次随访时为6.93±1.61mm。NDCS组颈椎曲度术前为11.66°±5.23°，术后3个月为14.88°±5.93°，术后1年为15.12°±6.12°，末次随访时为15.76°±5.29°；融合节段椎间高度术前为5.58±1.75mm，术后3个月为7.63±1.54mm，术后1年为7.19±2.09mm，末次随访时为7.14±1.74mm。两组颈椎曲度、融合节段椎间高度术后均较术前明显改善（P＜0.05），相同时间节点组间比较差异无统计学意义（P＞0.05）。所有患者术后1年随访时均获得骨性融合。末次随访时JOA评分改善优良率评价综合疗效：DCS组优18例，良10例，中2例，优良率93.33%；NDCS组优24例，良9例，中3例，优良率91.67%，两组JOA评分改善优良率的差异无统计学意义（P＞0.05）。结论：ACDF治疗单节段CSM伴DCS的患者，能有效改善神经功能，稳定性可靠，可重建颈椎曲度并恢复椎间高度，临床疗效满意。

英文摘要:

  【Abstract】 Objectives: To evaluate of clinical outcomes of the treatment of single-segment cervical spondylotic myelopathy with developmental cervical spinal canal stenosis by zero-profile interbody fusion device via anterior cervical discectomy. Methods: This article retrospectively analyzed 66 patients with single-segment cervical spondylotic myelopathy from June 2015 to June 2017 who were treated by ACDF in our hospital. The patients were divided into DCS group(30 cases) and NDCS group(36 cases) according to the presence of sagittal diameter of spinal canal/vertebral body<0.75 in consecutive 3 levels on lateral cervical radiographs. There were 21 males and 9 females in DCS group(aged 48.4±10.1 years), and 23 males and 13 females in NDCS group(aged 48.8±7.3 years). There was no significant difference in gender and age between the two groups(P>0.05). The follow-up period was 39.0±2.1 months in DCS group, and 39.2±1.9 months in NDCS group, which was no statistically significant difference between the two groups(P>0.05). Perioperative complications were recorded in both groups. Neck disabilitv index(NDI) score, Japanese Orthopaedic Association(JOA) score and X-ray were compared between the two groups before surgery, 3 months postoperatively, 1 year postoperatively, and at final follow-up. At the same time, cervical curvature (C2-C7 Cobb angle) and the height of intervertebral space at the fusion segment were measured on lateral cervical radiographs. The excellent rates of JOA improvement were compared between the two groups at final follow-up. Results: All the patients completed the surgery successfully. 3 patients(1 in the DCS group and 2 in the NDCS group) showed dysphagia after the surgery, however, the symptoms disappeared after 1 weeks of symptomatic treatment. There were no statistically significant differences between the DCS group and the NDCS group in operational time(78.2±10.4min vs 76.7±10.7min) and intraoperative blood loss(32.3±5.1ml vs 30.5±5.5ml), respectively(P>0.05). The JOA scores before surgery, at 3 months, 1 year after surgery, and final follow-up were 7.63±1.50, 12.73±1.41, 13.83±1.58, and 15.03±1.73 of DCS group, while those were 8.08±1.86, 12.97±1.70, 13.97±1.59, and 15.06±1.47 of NDCS group, respectively. The NDI scores before surgery, at 3 months, 1 year after surgery, and final follow-up were (38.42±5.90)%, (19.89±2.25)%, (13.67±2.99)%, and (4.83±3.66)% of DCS group, and (36.26±6.63)%, (19.96±3.05)%, (14.61±2.75)%, and (5.69±2.76)% of NDCS group, respectively. The JOA score and the NDI score were significantly improved in both groups after surgery(P>0.05), and they were with no significant differences between both groups at the same time point(P>0.05). In the DCS group, the Cobb angle was 11.27°±5.56° before surgery, 14.80°±5.53° at 3 months after surgery, 14.97°±5.11° at 1 year after surgery and 15.64°±4.86° at final follow-up, and the intervertebral height of fusion segment was 5.71±1.47mm before surgery, 7.56±1.43mm at 3 months after surgery, 7.07±1.84mm at 1 year after surgery and 6.93±1.61mm at final follow-up. In the NDCS group, the Cobb angle was 11.66°±5.23° before surgery, 14.88°±5.93° at 3 months after surgery, 15.12°±6.12° at 1 year after surgery and 15.76°±5.29° at final follow-up, and the intervertebral height of fusion segment was 5.58±1.75mm before surgery, 7.63±1.54mm at 3 months after surgery, 7.19±2.09mm at 1 year after surgery and 7.14±1.74mm at final follow-up. The Cobb angle and the intervertebral height of fusion segment were significantly improved in both groups after surgery(P>0.05). There was no significant difference between both groups at the same time point(P>0.05). All patients achieved bony fusion at 1 year follow-up. There was no significant difference in the excellent rates of JOA improvement between the two groups(P>0.05). Conclusions: ACDF the treatment of single-segment CSM with DCS has reliable stability, rebuild cervical curvature and restore the height of intervertebral space, and the clinical outcomes is satisfactory.