前路颈椎间盘切除和椎体次全切除植骨融合治疗临近两椎节脊髓型颈椎病（英文）  

Anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion for treating two-level contiguous cervical spondylotic myelopathy

作　　者：沈强[1] 丁浩[1] 朱宗昊[1] 朱亮[1] 魏小康[1] 贺旭峰[2] 

机构地区：[1]上海交通大学附属上海市第一人民医院骨科,上海市200080 [2]上海中医药大学附属曙光医院创伤科,上海市200025

出　　处：《中国组织工程研究》2016年第48期7175-7184,共10页Chinese Journal of Tissue Engineering Research

基　　金：The Key Project for Medical Science from the Shanghai Committee of Science and Technology of China,No.12441900702~~

摘　　要：背景:前路颈椎间盘切除植骨融合和前路颈椎椎体次全切除植骨融合广泛地被应用于治疗脊髓型颈椎病,此2种方法在治疗邻近两椎节连续性脊髓压迫颈椎病方面缺少长期随访的临床疗效和影像学比较研究。目的:确定前路颈椎间盘切除植骨融合和前路颈椎椎体次全切除植骨融合治疗连续双椎节脊髓型颈椎病临床疗效和放射影像学远期差异。方法:于2006年12月至2009年12月在上海交通大学附属上海市第一人民医院收集80例连续双椎节脊髓型颈椎病患者,随机等分为2组,分别接受前路颈椎间盘切除植骨融合和前路颈椎椎体次全切除植骨融合治疗,通过5年随访比较2组临床疗效和影像学方面的差异。结果与结论:2组患者随访时间62-98个月,平均83.6个月。5年随访期间,2组患者日本整形外科学会评分、目测类比评分、Odom’s评分、植骨融合率和并发症方面差异无显著性意义,且2组患者颈椎Cobb角和颈椎手术椎节段Cobb角差异无显著性意义。前路颈椎间盘切除植骨融合组患者术后1周内和术后5年随访时手术椎节高度均显著高于术前;而前路颈椎椎体次全切除植骨融合组患者手术椎节高度仅在术后1周内大于术前。术后1周内和术后5年时,前路颈椎间盘切除植骨融合组患者手术椎节高度大于前路颈椎椎体次全切除植骨融合组。2组植入物沉降率接近,且均未见植入物松动移位。所有患者在术后5年时均获得骨性融合。结果说明采用前路颈椎间盘切除植骨融合和前路颈椎椎体次全切除植骨融合治疗连续双椎节脊髓型颈椎病患者均可取得优良的临床疗效,且前路颈椎间盘切除植骨融合在恢复手术椎节高度方面优于前路颈椎椎体次全切除植骨融合。BACKGROUND： Anterior cervical discectomy and fusion with stand-alone cages and anterior cervical corpectomy and fusion with plate-mesh are widely used techniques in the treatment of cervical spondylotic myelopathy. There were less comparative studies about these two techniques in surgical treatment of two-level contiguous cervical spondylotic myelopathy patients based long-term follow-up. OBJECTIVE： To compare the efficacy between the anterior cervical discectomy and fusion and anterior cervical corpectomy and fusion procedures in patients with two-level contiguous cervical spondylotic myelopathy in clinical and radiological findings. METHODS： Between December 2006 and December 2009, 80 consecutive patients with two-level contiguous cervical spondylotic myelopathy were randomized into anterior cervical discectomy and fusion group and anterior cervical corpectomy and fusion group. The clinical and radiographic results were compared between the two groups. RESULTS AND CONCLUSION： The overall follow-up period of the patients ranged from 62 to 98 months（average 83.6 months）. There were no significant differences between the two groups in Japanese Orthopedic Association score, Visual Analog Scale score, Odom＇s criteria, fusion rates and complications. There were no significant differences between the two groups in the segmental and C2-7 Cobb angles at post-operation and 5-year follow-up. In anterior cervical discectomy and fusion group, both post-operative and 5-year follow-up segmental height was significantly larger than pre-operative segment height; in anterior cervical corpectomy and fusion group, only post-operative segmental height was significantly larger than pre-operative segmental height, not 5-year follow-up segmental height. More significant incensement of the segmental height was observed in anterior cervical discectomy and fusion cage group than that in anterior cervical corpectomy and fusion group at post-operative and 5-year follow-up. The instrument subsidence rates were similar between

关 键 词：骨移植 脊柱融合术 组织工程 骨科植入物 脊柱植入物 钛板 颈椎 椎间盘切除 脊柱前凸 脊髓病变 脊柱融合 目测类比评分 

分 类 号：R394.2[医药卫生—医学遗传学]