目的：比较前路椎间盘减压融合( ACDF)与前路椎体次全切除减压融合( ACCF)治疗多节段颈椎病的效果。方法将138例多节段脊髓型颈椎病患者按照治疗方式的不同分为观察组(行ACDF治疗)和对照组(行ACCF治疗),比较两组手术时间、术中出血量、术后住院时间、术前与术后6个月颈椎总活动度、颈椎曲度、颈椎节段性高度及JOA评分。结果手术时间：观察组(128．3±32．4)min,对照组(163．2±43．6)min；术中出血量：观察组(161．4±122．5)ml,对照组(319．2±308．7)ml；以上指标观察组均少于对照组(P<0．05)。术后住院时间：观察组(8．1±3．6)d,对照组(9．5±4．2)d；术后6个月时JOA评分：观察组(12．1±2．2)分,对照组(11．7±2．1)分；颈椎总活动度：观察组26．6°±7．3°,对照组30．5°±8．1°；以上指标两组间差异无统计学意义(P>0．05)。术后颈椎曲度：观察组23．5°±7．4°,对照组16．1°±7．2°；椎间节段性高度：观察组5．6°±0．4°,对照组4．7°±0．8°；以上指标两组比较差异有统计学意义(P<0．05)。结论 ACDF较ACCF手术时间短、术中出血量少、颈椎生理弯曲和椎间节段高度恢复更好。%Objective To compare the clinical efficacy of anterior cervical discectomy and fusion ( ACDF) and ante-rior cervical corpectomy and fusion ( ACCF) . Methods In order to provide reference for the treatment of multi-seg-mental cervical spondylotic myelopathy,138 cases of patients with multi-segmental cervical spondylotic myelopathy were divided into observation group and control group by different ways of treatment. The observation group received ACDF treatment, the control group received ACCF treatment. Compared the efficacy difference between the two groups in operation time, intraoperative blood soss, postoperative hospital stay,the cervical over-flexion and tablets activity,the cervical vertebrae physiology curvature,the heights of the cervical intervertebral space were followed up for 6 months preoperatively and 6 months postoperatively. And used the Japanese Orthopaedic Association scoring sys-tem(JOA) to evaluate the therapeutic effect. Results Operation time:observation group was (128. 3 ± 32. 4) min, the control group was(163. 2 ± 43. 6) min; blood loss: the observation group was(161. 4 ± 122. 5) ml, the control group was (319. 2 ± 308. 7) ml; observation group were all less than the control group (P<0. 05). Postoperative hospital stay:observation group was (8. 1 ± 3. 6) d, the control group was (9. 5 ± 4. 2) d;postoperative 6 months, JOA result:observation group was (12. 1 ± 2. 2) points, the control group was (11. 7 ± 2. 1) points; cervical total activity :observation group was 26. 6° ± 7. 3°, the control group was 30. 5 ° ± 8. 1°, among the above indicators there was no statistically significant differences ( P>0. 05 ) . Postoperative cervical curvature: the observation group was 23. 5° ± 7. 4°, the control group was 16. 1° ± 7. 2°;intervertebral segmental height:observation group was 5. 6° ± 0. 4°, the control group was 4. 7° ± 0. 8°; between these indicators there were statistically significant differences between groups ( P <0. 05 ) . Conclusions Compared with ACCF, ACDF has shorter operative time, less blood loss, cervical physiological curvature and height of intervertebral segment recovered well, but there is no statistically significant differences on postoperative hospital stay time, postoperative JOA score and cervical total activity.
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