经椎间隙减压与椎体次全切除术治疗相邻节段颈椎病的比较  

Comparative study of anterior decompression through intervertebral space with corpectomy for adjacent two-level cervical spondylosis

作　　者：蒋海平[1] 刘磊[1] 张雷炎[1] 谈俊[1] 

机构地区：[1]江苏大学附属宜兴市人民医院骨科,江苏214200

出　　处：《脊柱外科杂志》2010年第5期257-260,共4页Journal of Spinal Surgery

摘　　要：目的比较前路经椎间隙减压与椎体次全切除术治疗相邻节段颈椎病的临床疗效。方法回顾性分析2003年5月～2008年5月由同一组医师行颈前路手术治疗的相邻双节段颈椎病患者21例。依据手术方式分为2组。A组，椎间隙减压联合椎间融合器植骨融合组9例；B组，保留椎体后壁的颈前路椎体次全切除减压联合钛网植骨融合组12例。比较2组手术时间、术中出血量、住院花费、JOA评分、颈椎生理曲度及椎间高度变化，并观察植骨融合情况。结果B组中有2例原计划为行经椎间隙减压，术中改为行保留椎体后壁的次全切除减压术式。所有患者均随访18个月以上，平均22个月。B组手术时间略短于A组，出血量略低于A组，但差异均无统计学意义（P〉0．05）。末次随访时，2组的JOA评分差异无统计学意义（P〉0．05）。2组均无内置物松动或下沉。A组治疗费用高于B组，差异有统计学意义（P〈0．05）。2组术后3个月椎间高度及生理曲度较术前均有提高，但2组间差异无统计学意义（P〉0．05）。末次随访时植骨融合率为100％。结论2种方法治疗连续双节段颈椎病均可获得可靠临床疗效，并能获得术后稳定性。但椎间隙减压操作相对复杂，治疗费用略高。如术中出血较多影响术野，或者椎体后缘骨赘较多，难以操作，应及时更换手术方式。Objective To compare the clinical results of anterior decompression with anterior corpectomy for adjacent two- level cervical spondylosis. Methods From May 2003 to May 2008, 21 patients that suffered from two-level cervical spondylosis were treated by the same orthopedist with anterior surgical procedures. Nine of them that underwent anterior decompression with cervical bone grafting and fusion with cage made up Group A, while other 12 patients that underwent anterior cervical corpectomy with preserved posterior vertebral wall combined with titanium mesh fusion made up Group B. The evaluation index included duration of operation, intraoperative blood loss, costs of hospitalization, Japanese Orthopaedic Association （JOA） score evaluation, change of cervical vertebrae curvature （CVC） and intervertebral height, situation of fusion after bone transplantation. Results In Group B, anterior cervical corpectomy were performed for 2 cases instead of the original strategy anterior decompression intraoperatively. All the patients were followed up for at least 18 months with a mean time of 22 months. The duration of operation and intraoperative blood loss in Group B was less than Group A, but the difference was＇ t statistically significant （ P 〉 0.05 ）. The difference of JOA scores at the final follow-up between 2 groups was＇ t statistically significant （P 〉 0.05 ）. Neither of the groups had implantation loosening or protrusion. The costs of hospitalization in Group A was higher than Group B, and the difference was statistically significant （ P 〈 0.05 ）. The CVC and intervertebral height were both improved, but the difference between 2 groups was＇ t statistically significant （P 〉 0. 05 ）. The spinal fusion rate was 100% at the final follow-up. Conclusion Both methods can obtain positive effect and stability on adjacent two-level cervical spondylosis, but anterior decompression has a higher expense. It should change decompression to corpectomy if there is too much bleeding or osteophyma d

关 键 词：颈椎 减压术 外科 脊柱融合术 截骨术 骨移植 

分 类 号：R681.53[医药卫生—骨科学]