颈前路椎间盘切除和融合术对慢性椎间盘源性颈痛的疗效  

Analysis of the curative effect of anterior cervical discectomy and fusion for chronic cervical discogenic pain

作　　者：吴兵 彭宝淦[1] 何鑫 WU Bing;PENG Baogan;and HE Xin(Department of Spine Surgery,General Hospital of Chinese People＇s Armed Police Force,Beijing 100039,China;The Fourth Department of Orthopedics,The First Hospital of Qiqihar,Qiqihar 161000,China)

机构地区：[1]武警总医院脊柱外科,北京100039 [2]黑龙江省齐齐哈尔市第一医院骨四科,161000

出　　处：《中华灾害救援医学》2017年第12期694-697,共4页Chinese Journal of Disaster Medicine

摘　　要：目的分析颈前路椎间盘切除和融合术(anterior cervical discectomy and fusion,ACDF)对治疗慢性椎间盘源性颈痛的效果,并进一步探讨慢性椎间盘源性颈痛的发病机制。方法选取2014-03至2016-03武警总医院脊柱外科及上海长征医院脊柱外科收治的87例慢性椎间盘源性颈痛患者作为研究对象,其中51例接受了ACDF,36例拒绝接受手术,选择保守治疗。87例中有82例完成了为期1年的跟踪调查,其中包括手术组49例(手术组)和保守治疗组33例(保守组)。采用视觉模拟评分法(visual analogue scale,VAS)、颈椎功能障碍指数(neck disability index,NDI)和抑郁自评量表(self-rating depression scale,SDS)观察并分析两组的颈痛变化;同时,对比分析两组治疗后自评主观评价。结果 (1)治疗后各时间点两组的VAS评分和NDI值较治疗期前均显著降低(F=648.005,P<0.001;F=731.421,P<0.001),经LSD-t检验提示,手术组治疗后各个时间点VAS评分和NDI值较对照组降低更为明显(P<0.001)。(2)手术组的抑郁症状在治疗后短时间内有所改善,保守组未见明显改善。(3)手术组治疗后主观评价效果显著好于保守组,差异有统计学意义(Z=5.592,P<0.001)。结论与传统治疗方法相比,ACDF可显著缓解慢性椎间盘源性颈痛症状,减轻患者心理负担,改善其生活质量。Objective The objective of this study was to analyze the curative effect of anterior cervical discectomy and fusion（ACDF） in the treatment of chronic cervical discogenic pain and to further explore its pathogenesis. Methods A total of 87 patients suffering chronic cervical discogenic pain, treated in the department of spinal surgery of General Hospital of Chinese People＇s Armed Police Force and Shanghai Changzheng Hospital between March 2014 and March 2016, were selected as the study sample. The patients were divided into the surgery group, who were given ACDF（n=51） and the conservation group, who were provided with conservative treatment（n=36）. The patients were followed up for 1 year and their visual analogue scale（VAS） score, neck disability index（NDI） and self-rating depression scale（SDS） were observed and compared. The self-assessment rating post treatment of the two groups was analyzed. Results（1） VAS and NDI score at each time point of two groups after intervention were significantly reduced as compared to those prior to treatment（F=648.005,P〈0.001;F=731.421,P〈0.001）. The LSD-t test showed that VAS and NDI score at each time point of surgery group after intervention were significantly lower than those of conservation group（P〈0.001）.（2） The recovery from depression of the surgery group was more remarkable than that of the conservative group.（3） The effect on the self-assessment rating post treatment of the surgery group was better than that of the conservation group, the difference was statistically significant（Z=5.592,P〈0.001）. Conclusions Compared to traditional treatment, ACDF can significantly relieve the intensity of pain originating from the cervical disc, reduce the psychological burden and improve quality of life.

关 键 词：颈前路椎间盘切除和融合术 椎间盘源性颈痛 颈椎功能障碍指数 视觉模拟评分法 

分 类 号：R681.5[医药卫生—骨科学]