钩椎关节拐点辅助定位颈椎前路经椎间隙截骨融合术与颈椎前路椎体次全切融合术治疗伴椎间隙狭窄颈椎病的疗效对比

Comparison of the efficacy of anterior intervertebral osteotomy and fusion assisted with the inflection point of the Luschka joint with anterior cervical corpectomy and fusion for the treatment of cervical spondylosis with intervertebral space stenosis

中文关键词:  颈椎病  钩椎关节拐点  截骨减压  颈椎前路经椎间隙截骨融合术  颈椎前路椎体次全切融合术

英文关键词:Cervical spondylosis  Inflection point of Luschka joint  Osteotomy decompression  Anterior intervertebral osteotomy and fusion  Anterior cervical corpectomy and fusion

中文摘要:

  【摘要】 目的：将以钩椎关节拐点为辅助定位标记点的颈椎前路经椎间隙截骨融合术（anterior intervertebral osteotomy and fusion，AIOF）与颈椎前路椎体次全切融合术（anterior cervical corpectomy and fusion，ACCF）治疗伴椎间隙狭窄颈椎病的临床效果进行对比。方法：回顾性分析2016年6月~2021年6月于中国人民解放军中部战区总医院脊柱外科行手术治疗的80例伴椎间隙狭窄颈椎病患者，根据手术方式分为AIOF组与ACCF组。AIOF组38例，年龄51.2±16.3岁，随访时间为21.2±7.2个月；ACCF组42例，年龄54.0±13.2岁，随访时间为24.3±8.1个月，两组患者的年龄、性别、随访时间、手术节段等术前一般资料无统计学差异（P＞0.05）。通过比较两组患者的手术时间、术中出血量分析患者的围术期情况；通过两组患者术前、术后1周、术后3个月、6个月以及末次随访时患者的日本骨科协会评分（Japanese Orthopaedic Association，JOA）、颈部视疼痛觉模拟评分（visual analogue scale，VAS）的差异评估患者的手术疗效；分别在术前、术后3个月、术后6个月以及末次随访时通过X线、CT以及MRI测量脊髓直径、椎管面积、椎间孔面积、颈椎前凸角、颈椎活动度（range of motion，ROM）；记录患者术后并发症的发生率以及植骨融合情况。结果：所有患者手术顺利，AIOF组手术时间106.1±35.4min，术中出血量50.6±12.3mL；ACCF组手术时间121.4±42.3min，术中出血量150.3±37.7mL，两组手术时间无统计学差异（P＞0.05），但AIOF组患者术中出血量少于ACCF组（P＜0.05）。两组患者术后各时间点JOA评分与VAS评分均较术前有明显改善（P＜0.05）。末次随访时AIOF组JOA评分改善率为（72.3±10.4）%，VAS评分为0.8±0.6分；ACCF组JOA评分改善率为（63.7±12.1）%，VAS评分为1.2±0.7分，术后各时间点两组间比较均有统计学差异（P＜0.05）。末次随访时AIOF组患者的脊髓直径、椎管面积和颈椎ROM分别为5.4±1.1mm、128.2±10.1mm2、25.3°±6.3°，ACCF组分别为5.2±0.7mm、126±12.0mm2、24.2°±4.4°，两组比较均无统计学差异（P＞0.05）；两组椎间孔面积与颈椎前凸角（AIOF组49.7±8.8mm2、14.8°±4.8° vs ACCF组35.9±7.6mm2、6.7°±4.8°）均有统计学差异（P＜0.05）。术后AIOF组1例患者出现吞咽困难；ACCF组中有1例脑脊液漏、2例C5神经根麻痹、1例吞咽困难、2例融合失败，两组患者术后并发症的发生率有统计学差异（P＜0.05）。结论：对伴有颈椎间隙狭窄的颈椎病患者，AIOF在钩椎关节拐点辅助定位下比ACCF更安全地实现椎管内及椎间孔的减压，重建颈椎曲度，具有创伤小、并发症发生率低、椎间孔减压充分以及术后颈椎曲度改善更好的优势。

英文摘要:

  【Abstract】 Objectives: To compare the clinical outcomes between anterior intervertebral osteotomy and fusion(AlOF) assisted with the inflection point of the Luschka joint as an auxiliary localization landmark and anterior cervical corpectomy and fusion(ACCF) in the treatment of cervical spondylosis with intervertebral space stenosis. Methods: A retrospective analysis was conducted on 80 cervical spondylosis patients with intervertebral space stenosis who underwent surgical treatment in our department between June 2016 and June 2021. The patients were divided into the AIOF group and ACCF group based on the surgical approach. The AIOF group included 38 patients with a mean age of 51.2±16.3 years and a mean follow-up duration of 21.2±7.2 months. The ACCF group included 42 patients with a mean age of 54.0±13.2 years and a mean follow-up duration of 24.3±8.1 months. Statistical analysis revealed no significant differences in preoperative baseline characteristics, including age, gender, follow-up duration, and surgical levels, between the two groups(P>0.05). The perioperative conditions of the patients were analyzed by comparing the operation time and intraoperative blood loss between the two groups. The Japanese Orthopaedic Association(JOA) score and visual analogue scale(VAS) score of neck and upper limb pain before operation, at postoperative 1 week, 3 months, 6 months, and the final follow-up were compared between the two groups to assess the surgical outcomes. The spinal cord diameter, spinal canal area, intervertebral foraminal area, cervical lordosis angle, and cervical range of motion(ROM) were measured on X-ray, CT and MRI before operation, and at postoperative 3 months, 6 months, and final follow-up. The incidence of postoperative complications and bone graft fusion conditions were recorded and evaluated. Results: Both groups of patients underwent surgery successfully. The operation duration and intraoperative blood loss were 106.1±35.4min and 50.6±12.3mL in the AIOF group, which were 121.4±42.3min and 150.3±37.7mL in the ACCF group, respectively. There was no significant difference in the operation duration between the two groups(P>0.05), but intraoperative blood loss was significantly less in the AIOF group than in the ACCF group(P<0.05). Both groups showed significant improvements in JOA and VAS scores after surgery(P<0.05). At the final follow-up, in the AIOF group and ACCF group, the improvement rates of JOA score were (72.3±10.4)% and (63.7±12.1)%, and the VAS scores were 0.8±0.6 and 1.2±0.7, respectively, and there was statistically significant differences between the two groups at each postoperative time points(P<0.05). At the final follow-up, the spinal cord diameter, spinal canal area, and cervical ROM were 5.4±1.1mm, 128.2±10.1mm2, and 25.3°±6.3° in the AIOF group, and 5.2±0.7mm, 126±12.0mm2, and 24.2°±4.4° in the ACCF group, respectively, with no significant differences between the two groups(P>0.05). However, there were statistically significant differences in intervertebral foraminal area and cervical lordosis angle between the AIOF group(49.7±8.8mm2, 14.8°±4.8°) and the ACCF group(35.9±7.6mm2, 6.7±4.8°)(P<0.05). The AIOF group had one patient developed dysphagia after operation, while the ACCF group had one case of cerebrospinal fluid leakage, two cases of C5 nerve root palsy, one case of dysphagia, and two cases of fusion failure. The incidence of postoperative complications between the two groups was statistically significant(P<0.05). Conclusions: For patients with cervical spondylosis accompanied by intervertebral space stenosis, compared to ACCF, AIOF assisted by the inflection point of the Luschka joint can more safely achieve decompression within the spinal canal and intervertebral foramina and reconstruct cervical lordosis with the advantages of less trauma, lower incidence of complications, adequate intervertebral foraminal decompression, and better cervical lordosis after surgery.