连续性三节段颈椎前路椎间盘切除融合和杂交手术后5年随访矢状位序列影像学评价  

A5-year follow-up on sagittal alignment and radiological outcomes of consecutive three-level anterior cervical discectomy and fusion and hybrid surgery

作　　者：马龙[1] 谭小欣[1] 孙国绍[1] Ma Long;Tan Xiaoxin;Sun Guoshao(Pingdingshan First People's Hospital,Pingdingshan 467000,Henan Province,China)

机构地区：[1]平顶山市第一人民医院,河南省平顶山市467000

出　　处：《中国组织工程研究》2021年第12期1879-1885,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:在单节段与双节段颈椎病的治疗中,颈椎前路椎间盘切除融合与杂交手术均能恢复局部的颈椎前凸,并且对颈椎整体序列发挥作用,但该结论在3节段手术中的作用尚不明确。目的:对比连续性3节段颈椎前路椎间盘切除融合和杂交手术在治疗脊髓型颈椎病的矢状位序列、影像学参数和临床疗效差异。方法:选择平顶山市第一人民医院2007年2月至2013年9月收治的连续3节段脊髓型颈椎病患者93例,其中32例接受颈椎前路椎间盘切除融合治疗(ACDF组),36例接受单节段人工椎间盘置换和双节段椎间融合器杂交手术治疗(HS1组),25例接受双节段人工椎间盘置换和单节段椎间融合器杂交手术治疗(HS2组)。术后随访时拍摄颈椎X射线片,分析颈椎矢状位序列(C2-C7颈椎前凸角、C2-C7矢状位垂直距离、T1倾斜角)与解剖参数(颈椎活动度、上位和下位邻近节段颈椎活动度、手术节段颈椎前凸角与邻近节段退变),以颈椎功能障碍指数与日本骨科学会评分(JOA)评估临床疗效。试验获得平顶山市第一人民医院伦理委员会批准。结果与结论:93例患者平均随访(76.4±9.0)个月。(1)3组间末次随访的颈椎矢状位序列参数值比较差异均无显著性意义(P>0.05),3组间各参数值末次随访相对于术前的改变值比较差异均无显著性意义(P>0.05);(2)3组间末次随访的颈椎解剖参数值比较差异均无显著性意义(P>0.05),3组间各参数值末次随访相对于术前的改变值比较差异均无显著性意义(P>0.05);(3)3组末次随访的颈椎功能障碍指数与JOA评分均较术前明显改善(P<0.05),但3组间比较差异无显著性意义(P>0.05);(4)相关性分析显示,术后与末次随访的颈椎解剖参数及颈椎功能障碍指数与JOA评分无明确相关性;(5)结果表明对于连续3节段的脊髓型颈椎病,颈椎前路椎间盘切除融合和杂交手术均获得了明确的中长期疗效,且解剖学参数与BACKGROUND:In the treatment of single-and double-level cervical spondylosis,anterior cervical discectomy and fusion and hybrid surgery can restore local cervical lordosis,and play a role in the overall sequence of the cervical spine,but the role of this conclusion in three-level surgery is still unclear.OBJECTIVE:To compare sagittal alignment,radiological parameters and clinical outcomes between three-level hybrid surgery and anterior cervical discectomy and fusion on cervical spondylotic myelopathy.METHODS:Totally 93 patients with three-level cervical spondylotic myelopathy,who were treated in the Pingdingshan First People’s Hospital from February 2007 to September 2013,were enrolled in this study.Among them,32 patients underwent anterior cervical discectomy and fusion(anterior cervical discectomy and fusion group);36 patients underwent single-level disc replacement and double-level hybrid surgery(HS1 group);25 cases underwent doublelevel disc replacement and single-level hybrid surgery(HS2 group).X-ray films of cervical spine were taken during the follow-up.Sagittal alignment of cervical spine(C2-C7 cervical lordosis,C2-C7 sagittal vertical axis,and T1 slope)and anatomical parameters(range of motion,upper and lower adjacent range of motion,operated-segment lordosis,and adjacent segment degeneration)were analyzed.Neck disability index and Japanese Orthopedic Association score were used to assess clinical outcomes.This study was approved by the Ethics Committee of Pingdingshan First People’s Hospital.RESULTS AND CONCLUSION:Ninety-three patients were followed up for a mean of(76.4±9.0)months.(1)There was no significant difference in parameter values of cervical sagittal alignment among the three groups in the final follow-up(P>0.05).There was no significant difference in the value of each parameter among the three groups at the final follow-up compared with the change before the operation(P>0.05).(2)There was no significant difference in anatomical parameter values of the cervical spine at the final follow-up

关 键 词：骨 颈椎病 颈椎前路椎间盘切除融合 杂交手术 颈椎矢状位序列 影像学参数 临床疗效 中长期随访 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学]