两种前路手术治疗双节段脊髓型颈椎病的疗效比较  

Efficacy comparison of two anterior techniques in the surgical management of two-level cervical spondylotic myelopathy

作　　者：肖文德[1] 郭东明[1] 钟波夫[1] 刘恩志[1] 王立[1] 梁英杰[1] 陈豪逸 温世锋[1] 

机构地区：[1]广州医科大学附属广州市第一人民医院骨科,广东广州510180

出　　处：《临床骨科杂志》2016年第6期644-647,共4页Journal of Clinical Orthopaedics

基　　金：广东省科技计划项目(编号:2014A020212007)

摘　　要：目的：比较颈前路椎间盘切除减压融合术（ ACDF）和颈前路椎体次全切减压融合术（ ACCF）治疗双节段脊髓型颈椎病的临床疗效。方法将43例双节段脊髓型颈椎病患者按治疗方法分为两组, ACDF组23例,ACCF组20例。比较两组手术时间、术中出血量、住院时间、并发症发生率、术后JOA评分、植骨融合率和颈椎生理曲度改善情况。结果患者均获得随访,时间15-46个月。手术时间ACDF组为（106±23） min, ACCF组为（142±35）min；术中出血量ACDF组为（121±76）ml,ACCF组为（208±125）ml；两组两项比较差异均有统计学意义（P〈0．05）。两组住院时间、并发症发生率、植骨融合率比较差异无统计学意义（P〉0．05）。末次随访时JOA评分ACDF组从术前（10．32±1．47）分增加到（14．55±1．65）分,改善率62．82%±12．58%；ACCF组从术前（10．21±1．53）分增加到（14．39±1．76）分,改善率59．91%±13．28%；两组比较差异无统计学意义（P〉0．05）。术后颈椎生理曲度均得到明显改善,但ACDF组优于ACCF组,差异有统计学意义（P〈0．05）。结论 ACDF和ACCF治疗双节段脊髓型颈椎病均可取得满意的临床疗效,ACDF具有手术时间短、出血少、创伤小等优点。Objective To compare the clinical results between anterior cervical discectomy and fusion （ ACDF） and anterior cervical corpectomy and fusion （ ACCF ） for the treatment of two-level cervical spondylotic myelopathy （ CSM） . Methods A total of 43 consecutive patients who were divided into two groups according to treatment meth-od. There were 23 patients in group ACDF and 20 patients in group ACCF. The operation time, intraoperative blood loss, inpatient stay, complication incidence rates, JOA scores, rate of bone fusion and improvement in the physiologi-cal curvature in both groups were measured and compared. Results All cases were followed up for 15-46 months. Two groups of patients operative time were （ 106 ± 23 ） min, （ 142 ± 35 ） min, blood loss was （ 121 ± 76 ） ml, （208 ± 125） ml, the operative time and blood loss were significantly less in group ACDF than those in group ACCF （P〈0. 05）. There were no significant differences with respect to inpatient stay, complication incidence rates and rate of bone fusion between two groups （P〉0. 05）. In the last follow-up, JOA score of group ACDF increased from preoperative 10. 32 ± 1. 47 to 14. 55 ± 1. 65, with the improvement rate of 62. 82% ± 12. 58%; JOA score of group ACCF increased from preoperative 10. 21 ± 1. 53 to 14. 39 ± 1. 76, with the improvement rate of 59. 91% ± 13. 28%;and the differences were statistically insignificant （P〉0. 05）. Preoperative cervical physiological curvature improved significantly in both groups;however, the improvement was more obviously in group ACDF than in group ACCF, and the differences were statistically significant （P〈0. 05）. Conclusions There are excellent clinical outcomes in both ACDF and ACCF for treating two-level CSM. However, there is less blood loss, less operation time and little injury in group ACDF than those in group ACCF.

关 键 词：脊髓型颈椎病 颈前路减压 脊柱融合术 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]