颈前路经椎间隙扩大锥状减压融合术治疗严重椎间隙狭窄颈椎病的疗效观察

The effect of enlarged anterior cervical intervertebral cone-shape decompression and fusion for treating cervical spondylosis with severe intervertebral space narrowing

中文关键词:  颈椎病  颈前路减压融合手术  椎间隙狭窄  钩椎关节  疗效

英文关键词:Cervical spondylosis  Anterior cervical disectomy and fusion surgery  Intervertebral space narrowing  Uncinate vertebral joint  Effect

中文摘要:

  【摘要】目的：观察颈前路经椎间隙扩大锥状减压融合术（enlarged anterior cervical intervertebral cone-shape decompression and fusion，EACDF）治疗严重椎间隙狭窄颈椎病的临床疗效。方法：回顾性分析2015年1月~2020年7月采用颈椎前路减压融合手术治疗的135例严重椎间隙狭窄颈椎病患者的临床资料，其中53例患者行颈前路椎体次全切减压融合术（anterior cervical corpectomy and fusion，ACCF），纳入ACCF组；82例患者行EACDF，术中采用撑开扩大椎间隙、切除椎体部分后缘及部分钩椎关节的扩大减压方式，纳入EACDF组。对比两组间患者的年龄、性别、体质指数（body mass index，BMI），记录两组患者的手术时间、术中出血量、平均住院日，术前和术后即刻、2个月、12个月及末次随访时的颈肩部及上肢疼痛视觉模拟评分（visual analog scale，VAS）、颈椎残障指数（neck disability index，NDI）及日本骨科协会（Japanese Orthopaedic Association，JOA）评分，测量术前和术后即刻、2个月、12个月及末次随访时的颈椎整体曲度（C2-C7 Cobb角）、手术节段Cobb角、手术节段椎间高度、狭窄节段椎间孔高度及面积。记录两组植骨融合率及手术并发症。结果：两组间年龄、性别、BMI均无统计学差异（P>0.05），所有患者均顺利完成手术，术后随访24~78个月（47.74±20.36个月）。两组间手术时间、出血量、平均住院日均无统计学差异（P>0.05）。两组术后即刻、2个月、12个月及末次随访的颈痛与上肢痛VAS评分、NDI及JOA评分较术前均有明显改善（P<0.05）；两组间术前颈痛与上肢痛VAS评分、NDI及JOA评分均无明显差异（P>0.05），EACDF组术后即刻上肢痛VAS评分明显低于ACCF组（P<0.05），两组间术后2个月、12个月及末次随访时的颈痛与上肢痛VAS评分、NDI及JOA评分均无统计学差异（P>0.05）。EACDF组术后即刻、2个月、12个月及末次随访时的C2-C7 Cobb角、手术节段Cobb角、手术节段椎间高度、狭窄节段椎间孔高度及面积较术前均有明显改善（P<0.05）；ACCF组术后即刻、2个月、12个月及末次随访时的C2-C7 Cobb角、手术节段Cobb角、狭窄节段椎间孔面积较术前均明显改善（P<0.05），术后即刻手术节段椎间高度、狭窄节段椎间孔高度较术前均明显改善（P<0.05），但术后12个月和末次随访时的狭窄节段椎间孔高度较术前无明显差异（P>0.05）。两组间术前C2-C7 Cobb角、手术节段Cobb角、手术节段椎间高度、狭窄节段椎间孔高度及面积均无统计学差异（P>0.05），术后即刻、2个月、12个月及末次随访时EACDF组均明显大于ACCF组（P<0.05）。末次随访时两组均已植骨融合，ACCF组钛网下沉发生率20.75%。结论：相较于ACCF术式，EACDF能够获得一致的临床效果，并且在恢复椎间隙高度、纠正颈椎曲度及减压椎间孔狭窄方面更具优势。

英文摘要:

  【Abstract】 Objectives: To observe the clinical effect of the enlarged anterior cervical intervertebral cone-shape decompression and fusion(EACDF) for treating cervical spondylosis with severe intervertebral space narrowing. Methods: A retrospective case study of 135 patients suffered from cervical spondylosis with severe intervertebral narrowing treated with anterior cervical decompression and fusion in our hospital between January 2015 and July 2020 was conducted. Among them, 53 patients underwent anterior cervical corpectomy and fusion(ACCF) were included in ACCF group, and 82 patients who underwent EACDF with expanded decompression by distracted intervertebral space, partial resections of posterior edge of vertebral body and uncinate vertebral joint were included in EACDF group. The age, gender, and body mass index(BMI) of patients between the two groups were compared. The operation duration, blood loss, average length of hospital stay of the two groups of patients were recorded. The visual analog scale(VAS), neck disability index(NDI) and Japanese Orthopaedic Association(JOA) score were recorded before operation, immediately after operation, at 2 months and 12 months after operation, and final follow-up. The radiological parameters like C2-C7 Cobb angle of cervical global curvature, Cobb angle at the operative segment, intervertebral height of operative segment, height and area of intervertebral foramen in narrow segment were measured before operation, immediately after operation, at 2 months and 12 months after operation, and final follow-up. The fusion rate and operative complications were also recorded. Results: No significant differences were found between the two groups in age, gender, and BMI(P>0.05). The postoperative follow-up ranged from 24 to 78 months, with an average of 47.74±20.36 months. The operation duration, blood loss, and average length of hospital stay were similar in the two groups(P>0.05). There was no significant difference in neck and arm pain VAS, NDI, and JOA scores before operation between the two groups(P>0.05), while these parameters of both groups significantly improved respectively immediately after surgery, at 2 and 12 months after surgery, and final follow-up than preoperation(P<0.05). The arm pain VAS scores immediately after operation in the EACDF group was significantly lower than that in the ACCF group(P＜0.05). However, no significant differences were found between the two groups in the neck pain and arm pain VAS, NDI, and JOA scores at 2-month, 12-month and final follow-up(P>0.05). Besides, all radiological parameters in the EACDF group were improved after surgery at immediately after operation, 2-month, 12-month and final follow-up(P<0.05). The C2-C7 Cobb angle, Cobb angle at the operative segment, and the area of intervertebral foramen of narrow segment in the ACCF group were significantly improved immediately after operation, at 2-month, 12-month, and final follow-up, comparing with those before operation(P<0.05). In the ACCF group, the intervertebral height of operative segment and the height change of intervertebral foramen of narrow segment were significantly improved immediately after operation(P<0.05). However, there was no significant difference in the height of intervertebral foramen in narrow segment 12 months after operation and final follow-up compared with that before operation(P>0.05) There was no significant difference between the two groups in preoperative C2-C7 Cobb angle of cervical global curvature, Cobb angle at the operative segment, intervertebral height of operative segment, height and area of intervertebral foramen in narrow segment(P>0.05). These parameters in the EACDF group were significantly greater than those in the ACCF group immediately after operation, at 2-month, 12-month and final follow-up(P<0.05). At final follow-up, both groups of patients had bone graft fusion, and the incidence of titanium mesh subsidence in ACCF group was 20.75%. Conclusions: EACDF can achieve similar clinical effects with ACCF, and it's superior in restoring the height of intervertebral space, correcting the curvature of cervical spine, and decompressing the foraminal stenosis.