3种前路手术治疗单节段脊髓型颈椎病的中期疗效比较  

Comparative study of mid-term efficacies in three anterior procedures for treatment of single segment cervical spondylosis myelopathy

作　　者：李伟伟[1] 崔雅清[2] 王江华[2] 樊国峰[3] 寇明清[3] 吕长磊[3] 

机构地区：[1]陕西省人民医院骨科,陕西西安710068 [2]陕西省人民医院手术室,陕西西安710068 [3]陕西省人民医院影像科,陕西西安710068

出　　处：《中国骨与关节损伤杂志》2017年第5期453-457,共5页Chinese Journal of Bone and Joint Injury

基　　金：陕西省社会发展科技攻关项目(2015SF051)

摘　　要：目的比较分析颈前路椎间盘切除融合术(ACDF)、颈前路椎体次全切除融合术(ACCF)和人工颈椎间盘置换术(CADR)治疗单节段脊髓型颈椎病的中期疗效。方法回顾性分析自2004-01—2012-01行ACDF、ACCF和CADR手术治疗的79例单节段脊髓型颈椎病。ACDF组44例,ACCF组22例,CADR组13例。比较3组手术时间、术中出血量,术后6、60个月VAS评分、JOA评分、NDI指数、SF-12评分及颈椎曲度。结果 79例均获得61~88(69.8±12.7)个月随访。ACDF组与ACCF组植骨融合时间差异无统计学意义(P>0.05)。术后6个月时,ACCF组JOA评分均高于ACDF组及CADR组,ACDF组与ACCF组颈椎曲度优于CADR组,差异有统计学意义(P<0.05);而3组VAS评分、NDI指数和SF-12评分比较差异无统计学意义(P>0.05)。术后60个月时,ACDF组与CADR组VAS评分、NDI指数低于ACCF组,而SF-12评分高于ACCF组;ACDF组颈椎曲度优于ACCF组与CADR组,且CADR组优于ACCF组,差异有统计学意义(P<0.05);而3组JOA评分差异无统计学意义(P>0.05)。结论 ACCF在短期内神经功能恢复优于ACDF和CADR,但在随访中期ACCF在症状缓解、生活质量改善及颈椎曲度的维持方面却差于ACDF和CADR。Objective To compare the mid-term efficacies in anterior cervical discectomy and fusion （ACDF）, anterior cervical corpectomy and fusion （ACCF） and cervical artificial discreplacement（CADR） for treatment of single segment cervical spondylosis myelopathy. Methods Seventy-nine patients with single segment cervical spondylotic myelopathy, who underwent three different anterior procedures （ACDF, ACCF and CADR） from January 2004 to January 2012 were retrospectively analyzed. There were 44 cases of ACDF, 22 cases of ACCF and 13 cases of CADR. VAS, JOA, NDI, SF-12 score, total cervical curvature before and after operation （6th and 60th months postoperatively） and operation time and blood loss were used to evaluate the effect. Results Mean follow-up were 69.8±12.7 （61-88）months. There was no significant difference in the time of graft bone fusion between ACDF and ACCF （P 〉0.05）. In the 6th postoperative month, JOA score of group ACDF and CADR was lower than that of group ACCF, total cervical curvature of group ACDF and ACCF was better than that of group CADR （P 〈0.05） and there were no significant differences regard to VAS, NDI and SF-12 between these three groups （P 〉0.05）. In the 60th postoperative month, VAS and NDI of group ACDF and CADR were inferior to these of group ACCF, SF-12 score of ACDF and CADR was higher than that of group ACCF （P 〈0.05）. Total cervical curvature of group ACDF was greater than that of group CADR, and total cervical curvature of group CADR was greater than that of group ACCF as well （P 〈0.05）. Conclusion ACCF is easier for neural function recovery than ACDF and CADR in the short term, but its efficacy sustainment regard to symptom relief, living quality improvement and cervical curvature maintenance were poorer than those of ACDF and CADR in the mid-term follow-up.

关 键 词：脊髓型颈椎病 单节段 前路手术 颈前路椎间盘切除融合术 颈前路椎体次全切除融合术 人工颈椎间盘置换术 中期疗效 

分 类 号：R681.5[医药卫生—骨科学]