颈椎前路Hybrid手术治疗颈椎病的疗效观察  

The clinical effects of cervical anterior Hybrid surgery for cervical spondylosis

作　　者：郭雨霞 李春根 柳根哲[2] 尹辛成[2] 孙佩宇[2] 张翔[2] 陈超 齐英娜 GUO Yuxia;LI Chungen;LIU Genzhe(Beijing University of Chinese Medicine,Beijing,100029,China)

机构地区：[1]北京中医药大学,北京巿100029 [2]首都医科大学附属北京中医医院骨科,北京市100010

出　　处：《中国脊柱脊髓杂志》2021年第4期317-323,共7页Chinese Journal of Spine and Spinal Cord

摘　　要：目的:观察颈椎前路Hybrid手术(颈椎前路减压椎间融合术+颈椎全椎间盘置换术)治疗颈椎病的临床疗效。方法:收集2017年7月~2019年12月接受颈椎前路Hybrid手术的颈椎病患者的临床资料,符合纳入和排除标准并获得临床随访资料者共56例,其中获得完整影像学随访资料者40例。56例患者中神经根型颈椎病36例,混合型颈椎病12例,脊髓型颈椎病7例,交感型颈椎病1例;双节段病变39例,三节段病变17例;男25例,女31例;年龄34~72(54.23±8.72)岁。分别在术前、末次随访时记录患者田中靖久颈椎病症状量表评分(Tanaka Yasushi cervical spondylitis symptom scale 20 score,YT20评分)及颈椎JOA评分;在X线片上测量患者C2-7 Cobb角、手术节段脊柱功能单位Cobb角、C2-7矢状面轴向距离和T1倾斜角;依据Goffin标准对Hybrid手术后邻近节段退变(adjacent segment degeneration,ASD)进行分级。结果:56例患者的手术时间为88~360min(175.25±55.97min),术中出血量10~20ml(14.91±4.21ml),引流量5~80ml(17.92±17.13ml),住院时间4~29d(11.20±5.70d),随访时间6~29个月(11.59±6.11个月)。1例患者术后2d于切口附近出现血肿。末次随访时YT20评分和JOA评分均较术前显著好转(9.02±3.50 vs 17.18±3.24,P<0.05;14.38±1.93 vs 16.40±1.12,P<0.05),JOA评分改善率平均为81.12%(0%~100%);C2-7 Cobb角(1.59°±6.76°vs 5.60°±8.32°,P<0.05)、手术节段Cobb角(8.64°±10.68°vs 11.91°±10.94°,P<0.05)均较术前明显改善。末次随访时C2-7矢状面轴向距离(17.63±8.54mm vs 17.79±10.67mm,P>0.05)、T1倾斜角(23.32°±7.25°vs 24.42°±7.10°,P>0.05)较术前无统计学差异。末次随访时,40个上邻近节段中ASD发生率为20.00%,其中退变分级较术前增加1级的为12.50%,较术前增加2级的为7.50%;37个下邻近节段中ASD发生率为16.22%,其中退变分级较术前增加1级的为8.11%,较术前增加2级的为8.11%,均无较术前增加3级者。上邻近节段发生退变与未发生退变患者比较,�Objectives:To evaluate the clinical effects of the Hybrid surgery.Methods:Inpatients who underwent Hybrid surgery from July 2017 to December 2019 were retrospectively reviewed.56 patients(25/31 males/females)aged 54.23±8.72(34-72)years were enrolled,of which 40 cases underwent X-Ray.The cervical radiculopathy was in 36 cases,mixed cervical spondylosis in 12 cases,cervical spondylotic myelopathy in 7 cases,and sympathetic cervical spondylosis in 1 case.There were 39 cases with two-level lesion and 17 cases with three-level lesion.Clinical outcomes were assessed by the Tanaka Yasushi cervical spondylitis symptom scale 20 score(YT20 score),Japanese Orthopedic Association scale(JOA score).The changes of C2-7 Cobb angle,functional spinal unit(FSU)Cobb angle,C2-7 sagittal vertical axis(C2-7 SVA)and T1 slope(T1 S)were observed at pre-operation and the final follow-up.Adjacent segment degeneration(ASD)evolution was evaluated by Goffin′s criteria on cervical X-ray film.Results:Of all the 56 patients,the operation time was 88-360 min(175.25±55.97 min),intra-operative blood loss was 10-20 ml(14.91±4.21 ml),drainage volume was 5-80 ml(17.92±17.13 ml),length of stay was 4-29 d(11.20±5.70 d),and follow-up period was 6-29(11.59±6.11)months.Neck hematoma was shown in 1 case at 2 d postoperatively.Compared with pre-operation,the data showed better YT20(9.02±3.50 vs 17.18±3.24,P<0.05)and JOA score(14.38±1.93 vs 16.40±1.12,P<0.05)at the final follow-up,and the average improvement rate of JOA score was 81.12%(0%-100%).Compared with pre-operation,there were significant differences of C2-7 Cobb angle(1.59°±6.76°vs 5.60°±8.32°,P<0.05),FSU Cobb angle(8.64°±10.68°vs 11.91°±10.94°,P<0.05)at final follow-up.There were no significant differences of C2-7 SVA(17.63±8.54 mm vs 17.79±10.67 mm,P>0.05),T1 S(23.32°±7.25°vs 24.42°±7.10°,P>0.05)between pre-operation and final follow-up.ASD rate after Hybrid surgery:the ASD rate of superior level on X-ray film was 20.00%,and 1 and 2 grade was 12.50%and 7.50%respectivel

关 键 词：颈椎病 Hybrid手术 临床疗效 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]