ACCF和ACDF术式治疗脊髓型颈椎病的临床疗效及术后并发症评价  

Observation on the therapeutic effects of ACCF and ACDF on cervical spondylotic myelopathy and evaluation on the postoperative complications

作　　者：贾叙锋[1] 刘双 王彦博[1] 叶飞[1] 雷飞[1] 冯大雄[1] 

机构地区：[1]泸州医学院附属医院脊柱外科,四川泸州646000 [2]四川省合江县中医院骨科,646000

出　　处：《重庆医学》2014年第24期3201-3203,共3页Chongqing medicine

摘　　要：目的探讨不同手术方式治疗脊髓型颈椎病的临床疗效和术后并发症的发生情况。方法回顾性分析65例脊髓型颈椎病患者,其中31例行颈前路椎间盘切除融合术(ACDF),34例行颈前路椎体次全切钛网植骨钛板内固定术(ACCF),探讨两组患者手术一般情况、JOA评分和Nurick颈椎病脊髓功能分级以及吞咽困难发生情况等。结果 ACDF组患者手术时间(88.70±9.03)min、术中出血量(94.26±10.34)mL,ACCF组患者手术时间(125.46±12.62)min、术中出血量(133.98±12.09)mL,两组比较,ACDF组优于ACCF组,差异有统计学意义(P<0.05);两组患者术后住院时间、术前及术后6个月JOA评分、Nurick颈椎病脊髓功能分级比较,差异无统计学意义(P>0.05)。ACDF组患者在同一观察时间点,吞咽困难发生率及手术节段椎前软组织厚度均低于ACCF组,差异有统计学意义(P<0.05);两组均未出现植骨块松动移位、植骨不融合的情况。结论两种手术方式治疗脊髓型颈椎病均可取得满意的临床疗效,ACDF具有并发症发生率低的特点。手术方式,应根据实际情况选择。Objective To investigate the clinical therapeutic effects of different surgical treatments on cervical spondylotic my-elopathy and the occurrence of postoperative complications .Methods 65 patients with cervical spondylotic myelopathy admitted in our department between January 2010 and January 2013 were retrospectively analyzed ;and among them ,31 underwent anterior cer-vical discectomy and fusion（ACDF） and 34 underwent anterior cervical corpectomy and fusion （ACCF）;the general surgical condi-tions ,JOA scores and functional grades of Nurick ,incidences of dysphagia and so on in the patients of the two groups were investi-gated .Results The operative time and intra-operative blood loss of the patients of the ACDF group were better than those of the ACCF group[（88 .70 ± 9 .03）min ,（125 .46 ± 12 .62）min ,（94 .26 ± 10 .34）mL ,（133 .98 ± 12 .09）mL] ,and the differences were sta-tistically significant（P〈0 .05） .The postoperative lengths of stay of the two groups were similar ,and the differences in preoperative and postoperative JOA scores and functional grade of Nurick of the two groups were statistically insignificant （P〉0 .05）;but the differences between the preoperative and postoperative JOA scores and functional grade of Nurick in 6 months after the surgeries and those before the surgeries of the same groups were statistically significant （P〈0 .05） .At the same observation time points ,the incidences of dysphagia and the thicknesses of soft tissue before the cervical vertebra in the operated segment of the observation group were all lower than those of the control group ,and the differences were statistically significant （P〈0 .05）;in the patients of either group ,no loosening ,translocation or non-fusion of the bone graft was observed .Conclusion The two surgeries in treatment of cervical spondylotic myelopathy van both obtain satisfying clinical therapeutic effects ,but ACDF has a lower incidence of postop-erative complications ,and doctors should choose a suit

关 键 词：椎间盘切除融合术 椎体次全切植骨内固定术 钛网 脊髓型颈椎病 吞咽困难 

分 类 号：R687.3[医药卫生—骨科学]