人工颈椎间盘置换术与前路植骨融合内固定术治疗颈椎退行性疾病的疗效比较  

Comparison of curative effect of artificial cervical disc replacement and anterior fusion and internal fixation in the treatment of cervical degenerative diseases

作　　者：樊政炎 FAN Zheng-yan(the Second Department of Orthopaedics,People＇s Hospital of Yingcheng,Yingcheng,Hubei,432400,China)

机构地区：[1]应城市人民医院骨二科,湖北应城432400

出　　处：《颈腰痛杂志》2018年第5期610-613,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的对比分析人工颈椎间盘置换术(ACDR)与颈椎前路植骨融合内固定术(ACDF)治疗颈椎退行性疾病患者的临床效果及对颈椎运动功能、邻近节段退变的影响。方法回顾性收集152例颈椎退行性疾病患者临床资料,根据选择手术方式不同分为ACDR组(n=53)和ACDF组(n=99);比较两组临床疗效以及对术后颈椎运动功能、邻近节段退变的影响。结果 ACDR组Odom分级优良率为84.91%,ACDF组为85.86%,组间差异无统计学意义(P>0.05);末次随访时,两组VAS、NDI评分较术前明显降低(P<0.05),JOA评分较术前明显升高(P<0.05),且两组间差异无统计学意义(P>0.05);末次随访时,ACDR组颈椎整体曲度、手术节段曲度、邻近节段曲度与术前比较差异无统计学意义(P>0.05),而ACDF组颈椎整体活动度、手术节段活动度明显低于术前及ACDR组(P<0.05),上、下邻近节段活动度明显高于术前及ACDR组(P<0.05)。ACDR组ASDz发生率为13.21%,明显低于ACDF组的29.29%,差异有统计学意义(P<0.05)。结论 ACDR与ACDF疗效相当,而前者有保留手术节段活动度、维持颈椎生物力学稳定的优势,能够有效减少邻近节段退变的发生。Objective To compare the clinical effects of artificial cervical disc replacement（ACDR） and anterior cervical fusion （ACDF） in the treatment of cervical degenerative disease, and theeffect on cervical motion function and adjacent segment degeneration. Methods The clinical data of152 patients with cervical degenerative diseases were collected and divided into group ACDR （n=53）and group ACDF （n=99） according to the choice of surgical methods. The clinical effects of the twogroups were compared and the effects on the postoperative cervical motion function and adjacentsegment degeneration were compared. Results The excellent rate of Odom classification in ACDRgroup was 84.91%, and that of group ACDF was 85.86%. There was no significant difference betweenthe two groups （P〉0.05）. At the last follow-up, the scores of VAS and NDI in the two groups weresignificantly lower than before operation （P〈0.05）, and the JOA scores were significantly higher thanbefore operation （P〈0.05）, there was no statistically significant difference between the two groups. Atthe last follow -up, the overall curvature of the cervical spine, the curvature of the segment, thecurvature of the adjacent segment in the ACDR group had no significant differences compared withbefore operation （P 〉0.05）, while the overall activity of the cervical spine and the activity of thesegment in the ACDF group were significantly lower than before operation and those in the ACDRgroup （P〈0.05）, and the activity of the upper and lower adjacent segments was significantly higher thanbefore operation and that in the ACDR group （P〈0.05）. The incidence rate of ASDz in group ACDRwas 13.21% , which was significantly lower than 29.29% in group ACDF, the difference wasstatistically significant （P〈0.05）. Conclusion ACDR has the same effect as ACDF, while the former hasthe advantages of preserving the activity of the segment and maintaining the biomechanical stability ofthe cervical vertebra, and can effectively reduce th

关 键 词：颈椎退行性疾病 颈椎前路植骨融合 颈椎间盘置换 颈椎运动功能 邻近节段退变 

分 类 号：R826.62[医药卫生—临床医学] R681.5