颈前路减压植骨融合术与保守疗法治疗单节段颈椎间盘突出症的疗效评价

摘要

目的：对比研究采用颈前路减压植骨融合术与保守疗法治疗单节段颈椎间盘突出症的远期疗效，分析颈椎前路减压植骨融合术远期邻近节段间盘的退变程度。方法：选取2006年1月-2009年1月吉林省人民医院骨科收治的颈椎单节段病变患者120例，按患者意愿进行分组，其中手术组60例行颈前路植骨融合术，非手术组60例行保守治疗。2组患者发现病变时进行随访，在非手术组患者发现病变后60个月及手术组患者术后60个月再次进行随访，对患者进行美国脊髓损伤协会（ASIA）评分、疼痛视觉模拟（VAS）评分、日本矫形外科协会（JOA）脊髓功能评分及影像学评估（Miyazaki分级）。结果：107例患者获得随访，55例手术组患者平均随访59.7个月，52例非手术组患者平均随访58.8个月。与治疗前比较，手术组患者治疗后 ASIA、VAS和JOA评分均有改善，差异有统计学意义（P＜0.05）；与非手术组比较，手术组患者 ASIA、VAS和JOA评分差异也有统计学意义（P＜0.05）。手术组患者相邻节段上一邻近节段间盘的退变发生率明显高于下一邻近节段（P＜0.05）。结论：颈椎前路植骨融合术治疗单节段颈椎间盘突出症在缓解症状、改善预后方面优于保守疗法；颈椎前路单节段植骨融合术后远期间盘退变主要发生在上一邻近节段。%Objective To compare the long-term efficacies of anterior cervical decompression and fusion (ACDF)and conservative therapy in treatment of unisegmental cervical disc herniation and to analyze the degree of the long-term adjacent segment disc degeneration in ACDF.Methods 120 patients treated in our hospital from January 2006 to January 2009 were selected,60 patients underwent ACDF as operation group and 60 patients underwent physical therapy and drug (conservative therapy)as non-operation group. All the patients were recorded when they were diagnosed with cervical unisegmental cervical disc herniation, and followed-up for 60 months, and they were evaluated with American Spinal Injury Association (ASIA)score,Visual Analogue Scale (VAS),Japanese Orthopedics Association (JOA) score and imaging (Miyazaki grading system). Results 107 patients were followed up,55 patients treated by operation were followed up for an average 59.7 months (59.7±0.4),while 52 patients treated by conservative therapy were followed up for an average 58.8 months (58.8±1.5).Compared with before treatment, the ASIA, JOA, and VAS scores of the patients in two group after treatment were improved (P<0.05),and the scores of ASIA,VAS,and JOA in operation group were superior to that in non-operation group (P<0.05),and adjacent segment disc degeneration occurred more frequently in the upper adjacent segment than the lower adjacent segment (P<0.05).Conclusion ACDF is superior to conservative therapy in alleviating symptoms and improving prognosis of unisegmental cervical disc herniation. Long-term postoperative disc degeneration mainly occurrs in the upper segment.