颈前路手术治疗3节段脊髓型颈椎病

摘要

Objective To analyze the clinical outcomes of anterior cervical decompression and interbody fusion for three-segmental cervical spondylotic myelopathy.Methods A retrospective analysis was performed on 124 cases with three-segmental cervical spondylotic myelopathy who had undergone anterior cervical decompression.The patients were divided into anterior cervical discectomy and fusion(ACDF) group (78 cases) and anterior cervical corpectomy and fusion(ACCF) group(46 cases).The operative effects were evaluated by using the JOA scores and improvement rates,fusion rates and cervical curvatures.Results All cases were followed up for 13~54 (36.7± 15.1) months in ACDF group and 14~53(33.6±18.7) months in ACCF group.The postoperative JOA scores and cervical Cobb angles of two groups were significantly improved and regained,compared with preoperative ones (P<0.05).But ACDF group had better results in operation time,intraoperative blood loss,cervical curvature and operative complication than ACCF group (P<0.05).The postoperative JOA scores,improvement rate and bone graft fusion rate between the two groups were not statistically significant (P>0.05).Conclusions The postoperative neural functional recovery after ACDF procedure or ACCF procedure is satisfactory for three-segmental cervical spondylotic myelopathy.Meanwhile,ACDF procedure has better result in restoring cervical physiological curvature and lower incidence rate of postoperative complications.%目的 分析颈前路减压融合手术治疗3节段脊髓型颈椎病的临床疗效.方法 对124例3节段脊髓型颈椎病患者行颈前路手术治疗,78例行颈前路椎间盘切除减压融合术(ACDF),46例行颈前路椎体次全切除减压融合术(ACCF).评估术后JOA评分及其改善率、植骨融合情况以及颈椎曲度.结果 患者均获得随访,时间:ACDF组13~54(36.7± 15.1)个月,ACCF组14~53(33.6±18.7)个月.两组患者术后JOA评分及颈椎Cobb角均较术前显著提高及恢复,差异均有统计学意义(P<0.05).ACDF组在手术时间、术中出血量及颈椎生理曲度恢复程度方面均优于ACCF组,且并发症发生率更低(P<0.05).两组术后JOA评分及其改善率、植骨融合率比较差异无统计学意义(P>0.05).结论 ACDF与ACCF治疗3节段脊髓型颈椎病均可达到满意的神经功能恢复;ACDF治疗后颈椎生理曲度恢复较好,且并发症发生率较低.