前路通道与开放术治疗脊髓型颈椎病的近期临床疗效观察  

Short⁃term clinical effects of the minimally invasive tubular retractor assisted anterior cervical surgery vs.conventional surgery in the treatment of cervical spondylotic myelopathy

作　　者：蔡璇[1] 陈华佑 李陵江 张廷[1] 徐思越[1] 李浩鹏[1] 贺西京[1] CAI Xuan;CHEN Hua-you;LI Ling-jiang;ZHANG Ting;XU Si-yue;LI Hao-peng;HE Xi-jing(Department of Orthopaedics Surgery,Second Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710004,China;Department of Orthopaedics Surgery,Xi’an International Medical Center Hospital,Xi’an 710086,China)

机构地区：[1]西安交通大学第二附属医院骨二科,西安710004 [2]西安国际医学中心医院骨科医院,西安710086

出　　处：《骨科》2020年第5期398-404,共7页ORTHOPAEDICS

基　　金：陕西省自然科学基础研究计划项目(2019JQ⁃964)。

摘　　要：目的观察并比较微创通道辅助下颈椎前路椎体次全切除植骨融合术(anterior cervical corpectomy and fusion,ACCF)与常规开放ACCF术治疗双节段脊髓型颈椎病的近期临床疗效。方法对西安交通大学第二附属医院骨二科2017年6月至2019年6月收治的54例双节段脊髓型颈椎病病人进行回顾分析,其中采用微创通道辅助下ACCF手术治疗者32例(微创通道组),常规开放ACCF手术者22例(常规手术组)。观察比较两组病人手术时间、切口长度、术中出血量、术中透视次数、住院时间等一般指标;采用疼痛视觉模拟量表(visual analogue scale,VAS)评分、日本骨科协会(Japanese Orthopaedic Associ⁃ation,JOA)评分及颈椎功能障碍指数(neck disability index,NDI)评估并比较两组手术疗效;比较两组病人术后吞咽困难、喉返神经损伤等并发症发生情况。结果微创通道组病人术中出血量、手术切口长度及住院时间均小于常规手术组,差异均有统计学意义(P均<0.05);微创通道组和常规手术组病人术后3个月、6个月及末次随访时的VAS评分、JOA评分及NDI指数较术前均有改善,差异均有统计学意义(P均<0.05);两组间VAS评分、JOA评分及NDI指数比较,差异均无统计学意义(P均>0.05);微创通道组在随访期间内未见并发症,常规手术组有4例出现轻度吞咽困难,两组间比较,差异有统计学意义(P<0.05)。结论微创通道辅助下ACCF术治疗脊髓型颈椎病安全有效,与常规开放手术相比具有一定的优势。Objective To observe the short⁃term clinical effects of the minimally invasive tubular retractor assisted anterior cervical corpectomy and fusion(ACCF)vs.conventional ACCF in the treatment of two⁃segment cervical spondylotic myelopathy.Methods Fifty⁃four patients with two⁃segment cervical myelopathy admitted to our department from June 2017 to June 2019 were retrospectively analyzed and divided into two groups,of which 32 patients were treated with ACCF surgery assisted by minimally invasive tubular retractor(minimally invasive group),and 22 patients receiving conventional ACCF surgery(conventional surgery group).Operation time,incision length,intraoperative blood loss,intraoperative fluoroscopy times and hospitalization time were observed and compared.Visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)score and neck disability index(NDI)were used to evaluate and compare the surgical efficacy of the two groups.The complications such as dysphagia and recurrent laryngeal nerve injury were compared between the two groups.Results The intraoperative blood loss,surgical incision length,and length of hospital stay in the minimally invasive group were significantly reduced as compared with those in the conventional surgery group(P<0.05).The VAS score,JOA score and NDI index in the minimally invasive group and the conventional treatment group were significantly improved at 3rd and 6th month after the operation and at the last follow⁃up as compared with those before the operation(P<0.05).There was no significant difference in VAS score,JOA score and NDI index between the two groups(P>0.05).There were no complications in the minimally invasive group during the follow⁃up period,and 4 patients in the conventional surgery group had mild dysphagia.There was significant difference between the two groups(P<0.05).Conclusion ACCF surgery assisted by minimally invasive tubular retractor is safe and effective for the treatment of cervical spondylotic myelopathy,which has certain advantages over the conve

关 键 词：脊髓型颈椎病 颈椎前路椎体次全切除植骨融合术 微创通道 

分 类 号：R687.3[医药卫生—骨科学]