颈前路椎间盘切除减压融合术与椎体次全切除减压融合术治疗多节段脊髓型颈椎病疗效比较  

Comparison of anterior cervical discectomy and fusion and anterior cervical corpectomy and fusion for the treatment of multi-segmental cervical spondylotic myelopathy

作　　者：杨小奇[1] 齐新生[1] 茅治湘[1] 赵锡江[1] 

机构地区：[1]江南大学附属医院无锡市第四人民医院骨科,214062

出　　处：《中国医师进修杂志》2013年第26期30-33,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的 比较多节段脊髓型颈椎病（病变节段≥3个）采用两种颈前路减压植骨融合术治疗的疗效.方法 选择23例多节段脊髓型颈椎病患者,其中采用颈前路椎间盘切除减压融合术（ACDF）治疗10例（ACDF组）,颈前路椎体次全切除减压融合术（ACCF）治疗13例（ACCF组）.比较两组患者手术时间、术中出血量、JOA评分、神经功能改善率以及手术前后颈椎曲线深度D值变化量.结果 ACDF组手术时间和术中出血量分别为（130.0±31.5） min、（150.0±120.8） ml,均低于ACCF组的（150.0±42.5） min、（310.0±320.8） ml,差异均有统计学意义（P＜0.05）;ACDF组术后颈椎曲线深度D值变化量为（3.1±1.4） mm,高于ACCF组的（2.3±0.9） mm,差异有统计学意义（P＜0.05）;ACDF组JOA评分差值和神经功能改善率分别为（4.5±1.6）分、79.3％,ACCF组分别为（4.6±1.2）分、80.2％,两组比较差异无统计学意义（P＞0.05）.ACDF组出现脑脊液漏2例,经压迫及引流等治疗后恢复.ACCF组术后14d出现食管瘘并发症1例,经修补后痊愈;出现钛网移位2例,经随访获得融合.结论 ACDF与ACCF治疗多节段脊髓型颈椎病均能取得良好的减压效果,术后疗效良好.ACDF与ACCF比较手术时间短、术中出血量小、保持颈椎生理曲度的效果更优.Objective To compare the clinical results of two different anterior cervical surgical treatment for multi-segmental cervical spondylotic myelopathy （≥3 segments）.Methods Twenty-three patients with segmental cervical spondylotic myelopathy,10 cases were treated with anterior cervical discectomy and fusion （ACDF） as ACDF group,13 cases were treated with anterior cervical corpectomy and fusion （ACCF） as ACCF group.The operation time,operative blood loss,JOA scores,neurological improvement rate and the variable of the D value were compared.Results The operation time and operative blood loss in ACDF group was significantly lower than that in ACCF group [（130.0 ±31.5） min vs.（150.0 ±42.5） min,（150.0 ± 120.8） ml vs.（310.0 ± 320.8） ml,P ＜ 0.05].The variable of the D value in ACDF group was significantly higher than that in ACCF group [（3.1 ± 1.4） mm vs.（2.3 ± 0.9） mm,P ＜ 0.05].There was no statistically significant difference in JOA scores,neurological improvement rate between ACDF group and ACCF group.Two cases of cerebrospinal fluid leakage in ACDF group,the oppression and drainage recovery after treatment.One case of 14 d after fistula complications in ACCF group,after patching were cured; 2 cases of titanium mesh shift,follow the fusion.Conclusions Both methods attain good clinical results.ACDF combined with ACCF treatment of multi-segmental cervical spondylotic myelopathy,with shorter operation time,relatively less blood loss,and better restoration of cervical sagittal alignment.

关 键 词：脊柱融合术 脊髓型颈椎病 

分 类 号：R687.3[医药卫生—骨科学]