双节段Hybrid手术治疗颈椎病的临床疗效观察  

Clinical outcomes of Hybrid-Surgery to treat the two-level cervical disease

作　　者：刘海鹰[1] 许晓诺[1] 王波[1] 王会民[1] 朱震奇[1] 缪克难[1] 

机构地区：[1]北京大学人民医院脊柱外科,100044

出　　处：《中华外科杂志》2012年第3期238-242,共5页Chinese Journal of Surgery

摘　　要：目的评估颈椎人工间盘置换结合颈椎椎间融合（Hybrid手术）治疗颈椎病的临床疗效及其对相邻颈椎节段的影响。方法回顾性分析2007年12月至2010年6月共17例因颈椎病行双节段Hybrid手术患者（Hybrid组）的临床资料，选取同期行颈椎前路减压融合手术（ACDF）的17例患者作为对照（ACDF组）。对两组患者术前、术后1、3、6个月的日本骨科协会评分（JOA）、颈椎功能障碍指数评分（NDI）、C2-7，整体活动度、手术相邻颈椎节段活动度等结果进行对照评价。结果Hybrid组和ACDF组患者术后JOA评分、NDI评分较术前均有改善（JOA：t=-8．790--5．803，P〈0．05；NDI：t=10．717-13．514，P〈0．05），但两组之间差异无统计学意义（P〉0．05）。两组患者术后颈椎活动度较术前均明显降低，Hybrid组由术前46°±11°降至术后6个月的41°±8°（t=3．170，P〈0．05），ACDF组由术前的45°±13°降至术后6个月的38°±15°（t=6．709，P〈0．05），但两组之间差异无统计学意义（P〉0．05）。Hybrid组患者术后1、3个月上位相邻节段和下位相邻节段的颈椎活动度较术前均降低，差异有统计学意义（上位：t=5．622和4．032，P〈0．05；下位：t=2．879和2．207，P〈0．05），术后6个月时差异无统计学意义（P〉0．05）。ACDF组术后颈椎相邻节段活动度术后3、6个月时下位相邻节段颈椎活动度较术前升高，差异有统计学意义（t=-7．038和-13．540，P〈0．05），术后6个月时上位相邻节段颈椎活动度较术前升高，差异有统计学意义（t=-2．453，P〈0．05）。结论双节段Hybrid手术对于治疗颈椎病拥有满意的临床疗效和影像学结果，Hybrid手术患者在随访期间相邻节段颈椎活动度降低，而ACDF手术患者在随访期间相邻节段颈椎活动度增加。Hybrid手术的远期临床效果，还需要进-步随访验证。Objective To evaluate the clinical and radiologic outcomes of the Hybrid surgery （cervical artificial disc replacement combined with anterior cervical discectomy and fusion（ACDF） ） and the effective of the adjacent segment. Methods Between December 2007 to June 2010, 34 patients underwent 2-level cervical disc surgery. There were 17 patients underwent Hybrid surgery（Hybrid group）, 17 patients underwent 2-level ACDF （ ACDF group）. Japanese orthopaedic association （JOA） , neck disability index （NDI）, and Odom＇s standards were evaluated. Dynamic flexion and extension lateral cervical radiographs were obtained in the standing position before surgery and at routine postoperative intervals of 1,3, 6 months. Results Both of the two groups had significantly improvement than preoperative in JOA （ t = - 8. 790- -5. 803 ,P 〈 0. 05 ） and NDI scores （ t = 10. 717-13. 514, P 〈 0. 05 ）, but no significantly difference between the two groups （P 〉 0. 05 ）. Both of the two groups had significantly decreased in the mean C2-7 range of motion （ROM）. The Hybrid group decreased from 46°± 11° preoperative to 41°±8° at the 6 mouths after surgery （t=3. 170, P 〈 0. 05 ）. The ACDF group decreased from 45°± 13°preoperative to 38° ± 15°at the 6 mouths after surgery（ t = 6. 709, P 〈 0.05 ）. But there were no significantly difference between the two groups （P 〉 0. 05）. In the Hybrid group, both the superior adjacent segment ROM and the inferior adjacent segment ROM were decreased in the follow-up, there had significantly difference at the1 and 3 months after surgery （ superior adjacent segment： t = 5. 622 and 4. 032, P 〈 0.05 ; inferior adjacent segment ：t = 2. 879 and 2. 207,P 〈 0. 05 ）, but no significantly difference after 6 months （P 〉 0. 05 ）. In the ACDF group, the ROM of the inferior adjacent segment was significantly increased at 3 and 6 months after surgery（ t = -7. 038 and - 13. 540 ,P 〈 0. 05 ）, the ROM of the superior adjacent segme

关 键 词：颈椎病 颈椎 脊柱融合术 椎间盘 假体植入 

分 类 号：R687.3[医药卫生—骨科学]