双节段ACDF和单节段ACCF手术治疗脊髓型颈椎病疗效比较

摘要

Objective To compare the clinical outcomes between anterior cervical discectomy and fusion(ACDF) and anterior cervical corpectomy and fusion(ACCF)in treating the adjacent two segments cervical spondylotic myelop-athy.Methods 51 patients with cervical spondylotic myelopathy who underwent ACDF and ACCF between June 2009 and March 2014 were enrolled in this study.27 patients underwent ACDF and 24 patients underwent ACCF.We recor-ded operative time,blood loss,length of hospital stay,complications rates and fusion rates.The JOA score,VAS pain score,NDI index and Cobb angle data were obtained.Results In ACDF group,the mean follow-up was(30.2±10.5) months.The average operation time was(83.5±15.7)min.The average operative blood loss was(135.5±21.4)mL.The complications rates was 14.8%.The fusion rates was 88.9%.The average postoperative JOA score,VAS pain score,NDI index and Cobb angle improved significantly.In ACCF group,the mean follow-up was(28.3±12.1)months.The average operation time was(118.3±20.9)min,the average operative blood loss was(329.3±70.2)mL,the complications rates was 16.7%,the fusion rates was 91.7%.The average postoperative JOA score,VAS pain score,NDI index and Cobb an-gle improved significantly.No significant differences were found between 2 groups with respect to VAS pain score,NDI index and JOA score.The operation time、operative blood loss and postoperative Cobb angle of ACDF group was better than that of ACCF group.Conclusion 2-level ACDF has better outcomes compared with 1-level ACCF in treating adja-cent two segments cervical spondylotic myelopathy.It has shorter operation time,less bleeding and better Cobb angle.%目的：对比分析双节段前路颈椎间盘切除融合术（anterior cervical discectomy and fusion，ACDF）与单节段前路椎体次全切钛网植骨融合术（anterior cervical corpectomy and fusion，ACCF）治疗邻近双节段脊髓型颈椎病的临床疗效。方法回顾性分析2009年6月至2014年3月因邻近双节段脊髓型颈椎病在我院行ACDF和ACCF手术的51例患者。27例患者行 ACDF术（男性16例，女性11例），24例患者行 ACCF术（男性13例，女性11例）。记录患者一般资料、手术相关参数、并发症发生率、融合率等数据；在术前和术后随访时进行疼痛视觉模拟评分（visual ana-logue scale，VAS）、颈椎功能障碍指数（neck disability index，NDI）、日本矫形外科学会评分（Japanese orthopaedic asso-ciation，JOA）及测量颈椎Cobb角。结果 ACDF组平均随访时间为（30．2±10．5）个月，手术时间为（83．5±15．7）min，术中出血为（135．5±21．4）mL，术后并发症发生率为14．8％，术后3个月融合率为88．9％。术后3个月及末次随访的VAS评分、NDI指数、JOA评分、Cobb角均显著优于术前。ACCF组平均随访时间为（28．3±12．1）个月，手术时间为（118．3±20．9）min，术中出血为（329．3±70．2）mL，术后并发症发生率为16．7％，术后3个月融合率为91．7％。术后3个月及末次随访的 VAS评分、NDI指数、JOA评分、Cobb角均显著优于术前。ACDF组的术中失血量、手术时间以及术后Cobb角均显著优于 ACCF手术。结论双节段 ACDF手术和单节段 ACCF手术具有相似的临床效果，均能显著改善症状和恢复神经功能，不过 ACDF手术的术中失血量、手术时间以及颈椎曲度的恢复均优于 ACCF手术。因此在邻近双节段脊髓型颈椎病的治疗上，双节段 ACDF手术在一定程度上优于单节段 ACCF手术。