经椎间隙减压植骨融合术与椎体次全切除植骨融合术治疗多节段颈椎病的临床疗效比较  

Comparison of curative effect of anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion for multi segment cervical spondylosis

作　　者：陆建强[1] 张玉良[1] 周杨[1] Lu Jianqiang Zhang Yuliang Zhou Yang(Department of Orthopaedics, Jiaxing Hospital of Zhejiang Armed Police Corps, Jiaxing, Zhejiang 314100, China)

机构地区：[1]武警浙江省总队嘉兴医院骨一科,浙江省嘉兴314100

出　　处：《中国基层医药》2016年第21期3259-3262,共4页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的：了解经椎间隙减压植骨融合术与椎体次全切除植骨融合术治疗多节段颈椎病的临床疗效，为该疾病提供有效的前路术式。方法106例多节段颈椎病患者采用数字表法随机分为经椎间隙减压植骨融合术组（ACCF 组）54例和椎体次全切除植骨融合术组（ACDF 组）52例；ACDF 组采用经椎间隙减压植骨融合术治疗；ACCF 组采用椎体次全切除减压植骨融合术治疗。观察两组的手术时间、术中出血量和颈椎功能改善优良率，术后评价两组的植骨融合情况、颈椎高度变化和颈椎曲度变化。结果 ACDF 组的手术时间大于 ACCF 组，ACDF 组的术中出血量低于 ACCF 组，差异均有统计学意义（t ＝2．857、9．097，均 P ＜0．05）；术后6个月、12个月 ACDF 组的节段增加高度大于 ACCF 组，差异均有统计学意义（t ＝8．157、6．330，均 P ＜0．05）；术后6个月、12个月 ACDF 组的节段增加曲度、全颈椎增加曲度均低于 ACCF 组，差异均有统计学意义（t ＝4．707、4．575、4．083、3．987，均 P ＜0．05）；ACDF 组的并发症发生率11．5％（6／52），ACCF 组的并发症发生率13．0％（7／54），差异无统计学意义（χ2＝0．050，P ＞0．05）。结论对于多节段颈椎病，ACDF 与 ACCF 在疗效、稳定性方面均无明显差异；ACCF 术野更清晰，操作方便，手术时间短，有钛网下沉现象；在维持颈椎曲度方面 ACCF 明显优于 ACDF。Objective To study the curative effect of anterior cervical discectomy with fusion （ACDF）and anterior cervical corpectomy with fusion （ACCF）for multi segment cervical spondylosis;and to provide effective anterior surgery for the disease.Methods According to digital table,106 cases with multi segment cervical spondylosis were randomly divided into ACCF group of 54 cases and ACDF group of 52 cases.The ACDF group was treated with ACDF,and the ACCF group was treated with ACCF.The operation time,bleeding volume and excellent rate of cervical functional improvement of the two groups were observed,and the bone graft fusion,cervical vertebra height change and the change of cervical curvature of the two groups were evaluated.Results The operation time of the ACDF group was higher than that of the ACCF group,the amount of bleeding of the ACCF group was lower than that of the ACDF group,and the differences werestatistically significant （t =2.857,9.097,all P 〈0.05 ）.After 6 months and 12 months,the segments of the ACDF group were higher than those of the ACCF group,the differences were statistically significant （t =8.157,6.330,all P 〈0.05）.After 6 months and 12 months,the section curvature increases and cervical vertebra increased curvature of the ACDF group were lower than those of the ACCF group,the differences were statistically significant （t =4.707,4.575,4.083,3.987,all P 〈0.05）.The complication rate of the ACDF group was 11.5%（6 /52）,which of the ACCF group was 13.0%（7 /54）,the difference was not statistically significant （χ2 =0.050, P 〉0.05）.Conclusion For multi segment cervical spondylosis,there are no significant differences in efficacy and stability between ACDF and ACCF;ACCF surgery field is more clear and easy to operate,the operation time is short, and there is the phenomenon of titanium mesh sinking.In the maintenance of cervical curvature,ACCF is better than ACDF.

关 键 词：骨移植 减压术 外科 颈椎 

分 类 号：R687.3[医药卫生—骨科学]