颈前路椎间盘切除Zero-P椎间融合与钛板螺钉内固定Cage融合治疗颈椎病的疗效比较  

Comparison between anterior cervical discectomy Zero-P intervertebral fusion and anterior cervical discectomy with Cage fusion in treatment of cervical spondylosis

作　　者：徐浩钦 蒋登学 高春华[1] 王瑞军[1] 姜昊[1] 张倩[1] 彭宝淦[1] XU Haoqin;JIANG Denxue;GAO Chunhua;WANG Ruijun;JIANG Hao;ZHANG Qian;PENG Baogan(Department of Spine Surgery, General Hospital of Chinese People's Armed Police Force, Beijing 100039, China)

机构地区：[1]武警总医院脊柱外科,北京100039

出　　处：《中华灾害救援医学》2017年第5期266-270,共5页Chinese Journal of Disaster Medicine

摘　　要：目的比较颈前路椎间盘切除Zero-P椎间融合术(anterior cervical discectomy intervertebral fusion,ACIF)与钛板螺钉内固定Cage融合术(anterior cervical discectomy with fusion,ACDF)治疗颈椎病的临床效果。方法选取2011-06至2014-07武警某三甲医院脊柱外科收治的47例单节段颈椎病患者,其中行ACIF术18例(ACIF组),行ACDF术29例(ACDF组)。比较两组的手术时间、术中出血量、术后吞咽困难情况、手术并发症及临床疗效。吞咽困难采用Bazaz分级评估,临床疗效采用疼痛视觉模拟评分(visual analogue scale,VAS)、日本骨科协会评分(Japanese Orthopaedic Association scores,JOA)进行评价,并比较两组VAS、JOA评分及融合率、椎间高度的变化。结果 47例患者获得平均(21.57±2.45)个月的随访。两组手术时间、术中出血量、术后融合时间、并发症、术后吞咽不适、融合率、椎间高度维持及VAS、JOA评分在各时间节点的组间比较,差异无统计学意义;但两组手术前后VAS、JOA评分组内比较,差异有统计学意义(P<0.05);两组术后出现吞咽困难人数比较,差异有统计学意义(χ2=6.838,P=0.009)。结论 ACIF与ACDF两种术式在神经功能恢复及疼痛改善上都有良好效果,但ACIF具有手术时间短,术中出血少,融合率高,融合节段椎间高度更好的维持及较少引起患者术后吞咽不适等优点。Objective This study aimed to compare the clinical effects of anterior cervical discectomy with fusion(ACDF)and anterior fusion fixation system(ACIF)in the treatment of single-level cervical spondylopathy.Methods A total of sample of47patients with single-level cervical spondylopathy enrolled in the spinal surgery department of a third-grade class-A PAP hospital from June2011to July2014were selected,of which29cases received ACDF(ACDF group)and18cases received ACIF(ACIF group).The operation time,amount of intraoperative bleeding,postoperative dysphagia,postoperative complications,and clinical effect were compared between the two groups.Postoperative dysphagia was assessed by Bazaz-Yoody dysphagia score.The surgical effect was evaluated by visual analogue scale(VAS),Japanese Orthopaedic Association Score(JOA),and the scores of VAS,JOA and the changes of fusion rate and intervertebral height were compared between the two groups.Results47cases of patients were followed up at an average of(21.57±2.45)months.The difference between the two groups in operation time,intraoperative blood loss,postoperative fusion time,complication,postoperative dysphagia,fusion rate,intervertebral height maintenance and the scores of VAS and JOA was not statistically significant.However,the scores of VAS and JOA of the two groups were compared before and after surgery,and the difference was statistically significant(P<0.05).The difference between the two groups in the number of patients with postoperative dysphagia was statistically significant(χ2=6.838,P=0.009).Conclusions Both ACIF and ACDF have a good effect on neurological recovery and pain improvement,but ACIF has shorter operation time,less intraoperative blood loss,higher fusion rate,better intervertebral height maintenance,and less incidence of postoperative dysphagia.

关 键 词：颈椎病 Cage植骨融合 Zero-P植骨融合 吞咽困难 

分 类 号：R681.5[医药卫生—骨科学]