两种颈前路减压融合术治疗两节段脊髓型颈椎病的疗效分析
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作者Author单位AddressE-Mail
陈恩良 CHEN En-liang 杭州市萧山区中医院骨科, 浙江 杭州 311201 Department of Orthopaedics, Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China  
王楠 WANG Nan 杭州市萧山区中医院骨科, 浙江 杭州 311201 Department of Orthopaedics, Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China wangnan1105@126.com 
全仁夫 QUAN Ren-fu 杭州市萧山区中医院骨科, 浙江 杭州 311201 Department of Orthopaedics, Xiaoshan Hospital of Traditional Chinese Medicine, Hangzhou 311201, Zhejiang, China  
期刊信息:《中国骨伤》2020年,第33卷,第9期,第841-847页
DOI:10.12200/j.issn.1003-0034.2020.09.010
基金项目:
中文摘要:目的:探讨颈前路椎间盘切除融合术(anterior cervical discectomy with fusion,ACDF)与颈前路椎体次全切减压融合术(anterior cervical corpectomy with fusion,ACCF)治疗相邻两节段脊髓型颈椎病的临床疗效。

方法:对2016年1月至2017年12月收治的相邻两节段脊髓型颈椎病37例患者的临床资料进行回顾性分析,男15例,女22例,年龄43~69岁,平均54.6岁。根据手术方法的不同分为ACDF治疗组(A组,17例)和ACCF治疗组(B组,20例)。记录两组患者的手术时间、术中出血量,比较两组患者术前及术后1、12个月颈椎融合节段Cobb角、颈椎曲度,采用日本矫形外科协会(Japanese Orthopaedic Association,JOA)评分评价临床疗效,并观察两组术后并发症情况。

结果:所有患者获得随访,时间12~24个月,平均18.5个月。手术时间、术中出血量A组分别为(106.3±22.6)min、(52.2±26.4)ml,B组分别为(115.6±16.8)min、(61.7±20.7)ml,手术时间组间差异无统计学意义(P>0.05),B组术中出血量大于A组(P<0.05)。术前及术后1、12个月颈椎曲度和颈椎融合节段Cobb角A组分别为(11.28±1.40)°、(17.56±1.90)°、(16.64±1.80)°和(4.93±4.20)°、(9.44±2.60)°、(9.25±2.80)°,B组分别为(10.59±1.20)°、(16.26±2.10)°、(15.76±2.50)°和(4.75±3.90)°、(7.98±2.10)°、(7.79±3.00)°。两组患者术后颈椎融合节段Cobb角、颈椎曲度均较术前明显改善,且A组较B组恢复更明显(P<0.05)。术前及术后1、12个月JOA评分A组分别为9.46±1.70、11.56±1.40、14.86±1.20,B组分别为9.11±1.50、11.40±1.30、15.12±1.60。两组患者术后JOA评分较术前均明显改善(P<0.05),组间同时间段比较差异无统计学意义(P>0.05)。末次随访A组出现吞咽梗阻感2例,cage移位1例,未发生钛板螺钉松动;B组出现吞咽梗阻感4例,钛网沉降2例,钛板螺钉松动1例。

结论:两种颈前路减压融合术治疗两节段脊髓型颈椎病,均能有效减压,改善病椎Cobb角及颈椎生理曲度。ACDF术式可直接去除椎间水平的致压物,椎体破坏小,颈椎生理曲度恢复良好;ACCF术式椎体次全切除,操作空间大,易于去除椎体后缘骨赘及钙化的后纵韧带。长期随访显示,ACDF与ACCF术式效果良好,技术成熟,疗效接近。
【关键词】脊髓型颈椎病  颈前路椎间盘切除融合术  颈前路椎体次全切减压融合术  减压术  脊柱融合术
 
Comparison of clinical effects of two anterior cervical decompression with fusion on treating two-segment cervical spondylotic myelopathy
ABSTRACT  Objective: To explore the clinical effects of anterior cervical discectomy with fusion (ACDF) and anterior cervical corpectomy with fusion (ACCF) in treating adjacent two-segment cervical spondylotic myelopathy (CSM).

Methods: The clinical data of 37 patients with adjacent two-segment CSM treated from January 2016 to December 2017 were retrospectively analyzed,including 15 males and 22 females,aged from 43 to 69 years old with an average of 54.6 years. The patients were divided into ACDF group (group A,n=17) and ACCF group (group B,n=20) according to the different surgery. The operation time and intraoperative blood loss were recorded;the Cobb angle and cervical curvature in the cervical fusion segments before surgery and 1,12 months after surgery were observed;Japanese Orthopaedic Association (JOA) score was used to evaluate the surgical efficacy,and the postoperative complications were analyzed.

Results: All patients were followed up for 12 to 24 months with an average of 18.5 months. Operation time and intraoperative blood loss in group A were (106.3±22.6) min, (52.2±26.4) ml,respectively,while were (115.6±16.8) min, (61.7±20.7) ml in group B. There was no statistically significant in operation time between two groups (P>0.05);intraoperative blood loss in group B was larger than group A (P<0.05). The preoperative and postoperative 1 and 12 months,cervical curvature and Cobb angle of cervical fusion segment in group A were (11.28±1.40)°, (17.56±1.90)°, (16.64±1.80)° and (4.93±4.20)°, (9.44±2.60)°, (9.25±2.80)°,respectively,and in group B were (10.59±1.20)°, (16.26±2.10)°, (15.76±2.50)° and (4.75±3.90)°, (7.98±2.10)°, (7.79±3.00)°. The cervical curvature and Cobb angle in all cervical fusion segments at 1,12 months after surgery were obviously improved,and group A recovered more significantly than group B (P<0.05). The JOA scores in group A were 9.46±1.70,11.56±1.40,14.86±1.20 before operation and 1 and 12 months after operation,and group B were 9.11±1.50,11.40±1.30,15.12±1.60,respectively. The postoperative JOA scores of the two groups were significantly improved (P<0.05),and there was no statistically significant difference between two groups at the same time (P>0.05). At the final follow-up,in group A,dysphagia occurred in 2 cases,cage displacement in 1 case,and no titanium plate screw loose was found;and in group B,dysphagia occurred in 4 cases,titanium mesh collapse in 2 cases,titanium plate screw loose in 1 case.

Conclusion: Two types of anterior cervical decompression and fusion for the treatment of two-segment cervical spondylotic myelopathy can effectively decompress and improve the Cobb angle and cervical curvature of the affected vertebra. The ACDF surgical procedure can directly remove the compressive thing at intervertebral level,which will lead to little vertebral body damage and favorably recovered cervical curvature. The ACCF surgical procedure has a large operation space,which can easily remove the posterior vertebral osteophyte and the calcified posterior longitudinal ligament. Long-term follow-up shows that ACDF and ACCF have good surgical procedures,mature technology,and close efficacy.
KEY WORDS  Cervical spondylotic myelopathy  Anterior cervical discectomy with fusion  Anterior cervical corpectomy with fusion  Decompression  Spinal fusion
 
引用本文,请按以下格式著录参考文献:
中文格式:陈恩良,王楠,全仁夫.两种颈前路减压融合术治疗两节段脊髓型颈椎病的疗效分析[J].中国骨伤,2020,33(9):841~847
英文格式:CHEN En-liang,WANG Nan,QUAN Ren-fu.Comparison of clinical effects of two anterior cervical decompression with fusion on treating two-segment cervical spondylotic myelopathy[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(9):841~847
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