ACCF、ACDF及Hybrid三种手术方案对连续双节段脊髓型颈椎病患者的疗效与安全性比较  

Comparison of the effects and safety of ACCF,ACDF and Hybrid three surgical procedures for patients with bi-level cervical disc degenerative disease

作　　者：张先莉[1] 朱利峰[1] ZHANG Xian-li;ZHU Li-feng(Department of Orthopaedics,the Affiliated Hospital of Inner Mongolia Medical University,Hohhot 010050,China)

机构地区：[1]内蒙古医科大学附属医院骨科,呼和浩特010050

出　　处：《中国医学前沿杂志（电子版）》2018年第12期104-109,共6页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的比较椎体次全切除减压融合内固定术(anterior cervical corpectomy with fusion,ACCF)、椎间盘切除减压融合内固定术(anterior cervical discectomy with fusion,ACDF)及Hybrid三种手术方案对连续双节段脊髓型颈椎病患者的疗效与安全性。方法回顾性分析2006年1月至2011年12月本院收治的行手术治疗的88例连续双节段脊髓型颈椎病患者的临床资料,根据手术方式将其分为ACCF组(28例)、ACDF组(37例)及Hybrid组(23例),比较三组患者的基线资料、围术期资料与随访结果。结果三组患者基线资料、手术时间、术中失血量、引流量及住院天数比较均无显著差异(P_均> 0.05)。全部患者均顺利完成手术操作,围术期无严重并发症发生,无一例死亡。所有患者术后随访48～105个月,中位随访时间为78个月,ACCF组、ACDF组、Hybrid组患者的中位随访时间分别为80.1个月、78.6个月、77.2个月。组内比较:末次随访时,三组患者视觉模拟评分法(visual analogue scale,VAS)评分均显著低于术前(P均<0.05),日本骨科协会(Japanese Ortho paedic Association,JOA)评分均显著高于术前(P_均<0.05),颈椎生理曲度Cobb角均显著大于术前(P_均<0.05),且ACCF组和ACDF组患者颈椎整体关节活动度(range of motion,ROM)和手术节段ROM均显著低于术前(P_均<0.05),相邻节段ROM均显著高于术前(P_均<0.05);Hybrid组患者手术前后ROM比较均无显著差异(P_均> 0.05)。组间比较:末次随访时,三组患者VAS评分、JOA评分、Odom's分级标准、邻近节段退变率比较均无显著差异(P_均> 0.05);Hybrid组患者颈椎生理曲度Cobb角均显著大于ACCF组和ACDF组(P均<0.05),颈椎整体ROM与手术节段ROM均显著高于ACCF组和ACDF组(P均<0.05),相邻节段ROM均显著低于ACCF组和ACDF组(P_均<0.05),且ACDF组患者颈椎生理曲度Cobb角显著大于ACCF组(P <0.05)。所有患者末次随访时融合节段均实现骨性融合。结论 ACCF、ACDF、Hybrid三种手术方案对�Objective To compare the effects and safety of anterior cervical corpectomy with fusion(ACCF),anterior cervical discectomy with fusion(ACDF)and Hybrid surgical procedures for patients with bi-level cervical disc degenerative disease.Method88patients with bi-level cervical disc degenerative disease underwent surgical treatment from January2006to December2011were enrolled in the study and they were divided into ACCF group(28cases),ACDF group(37cases)and Hybrid group(23cases)according to the surgical procedures.The baseline data,perioperative data and follow-up Result s were compared among the three groups.Result There were no significant differences in baseline data,operation time,intraoperative blood loss,drainage and hospital stay among the three groups(Pall>0.05).All patients successfully completed the operation,no serious complications occurred and no death occurred during the perioperative period.All patients were followed up for48~105months,and the median time was78months.The median follow-up time of ACCF group,ACDF group and Hybrid group were80.1months,78.6months and77.2months,respectively.Intra-group comparison:At the last follow-up,the visual analogue scale(VAS)scores of the three groups were significantly lower than those before operation(Pall<0.05),and the Japanese Orthopaedic Association(JOA)scores of cervical spine were significantly higher than those before operation(Pall<0.05),and the Cobb angle of cervical physiological curvature were significantly larger than those before operation(Pall<0.05),the ROM of the whole cervical spine and the operative segment in ACCF group and ACDF group were significantly lower than those before operation(Pall<0.05),and the range of motion(ROM)of adjacent segments were significantly higher than those before operation(Pall<0.05);there were no significant differences in the ROM of Hybrid group before and after operation(Pall>0.05).Inter-group comparison:at the last follow-up,there were no significant differences in VAS scores,JOA scores,Odom's grade and adjacent segment d

关 键 词：颈椎病 Hybrid手术 椎体次全切除术 椎间盘切除术 椎间融合术 邻近节段退变 

分 类 号：R687.3[医药卫生—骨科学]