颈前路椎间盘切除融合术与颈后路椎板切除减压术治疗多节段脊髓型颈椎病的对比研究

摘要

Background:There are many arguments about the approach and operation of multisegment cervical spondylotic myelopathy (CSM). Anterior cervical decompression and fusion can maintain the stability of the cervical spine and correct the deformity of the cervical spine through the anterior fusion of the spine at the same time. The more commonly used ante-rior surgery includes anterior cervical discectomy and fusion (ACDF) and anterior cervical corpectomy and fusion (ACCF). Objective:To compare the effect of ACDF and CLF for the treatment of multi segment CSM. Methods:Eighty patients with multisegmental CSM (≥3 intervals) treated between January 2010 and June 2015 were enrolled in this retrospective analysis. ACDF was used in 40 patients, and CLF in another 40 patients. There were no significant differences in gender, age, disease duration, involved segments, preoperative Japanese Orthopaedic Association (JOA) score, and cervical curvature of C2-7 be-tween two groups (P>0.05). JOA scores, the improvement of spinal cord function, the length of hospital stay, intraoperative blood loss, operation time, cervical lordosis, fusion rate and complications were compared between ACDF and CLF. Results:JOA scores and spinal cord function improvement were significant increased after surgery in both groups. JOA scores and spinal cord function improvement rate in ACDF group were significantly higher than those in CLF group (P<0.05). There were no significant differences in the length of hospital stay, cervical lordosis, intraoperative blood loss, operation time, fu-sion rate between the two groups (P>0.05). Conclusions:ACDF may be the first choice for the multi-segmental CSM.%背景:目前多节段脊髓型颈椎病(cervical spondylotic myelopathy,CSM)手术治疗应采用何种入路或术式尚存争论.颈椎前路减压融合术可以在解除压迫的同时通过前路的脊柱融合来保持颈椎的稳定性,并纠正颈椎的后凸畸形,较为常用的前路手术包括颈前路椎间盘切除植骨融合术(anterior cervical discectomy and fusion,ACDF)与椎体次全切除融合术(anterior cervical corpectomy and fusion,ACCF)两种.目的:比较颈ACDF与CLF治疗多节段CSM的早期临床治疗效果.方法:回顾性分析2010年1月至2015年6月收治的符合选择标准的80例多节段(≥3个间隙)脊髓型颈椎病患者,根据手术方式分为两组,A组采用ACDF,B组采用CLF,每组各40例.两组患者的性别、年龄、病程、病变节段、术前日本骨科协会(JOA)评分及颈椎曲度(C2~7夹角)等一般情况无统计学差异(P>0.05),具有可比性.比较两组患者的术后JOA评分、颈髓功能改善率、平均住院天数、术中失血量、手术时间、颈椎曲度、手术节段融合率与并发症等临床治疗效果.结果:两组患者术后1年的JOA评分、颈髓功能改善率较术前均有明显提高(P<0.05).A组在JOA评分和颈髓功能改善率方面明显优于B组(P<0.05),两组在平均住院天数、颈椎曲度、术中失血量、手术时间、手术节段融合率方面无统计学差异(P>0.05).结论:ACDF减压彻底,疗效确切可靠,可作为多节段CSM的首选治疗方案.CLF手术操作相对简单,也可作为多节段CSM的一个术式选择.