颈前路ACCF术精准治疗多节段脊髓型颈椎病的疗效  

Clinical effect of ACCF in the treatment of multilevel cervical spondylotic myelopathy

作　　者：王义生 唐福兴[1] 黄燕 卢波[1] 梁博伟 WANG Yi-sheng;TANG Fu-xing;HUANG Yan;LU Bo;LIANG Bo-Wei(Department of Orthopaedics,Yulin Red Cross Hospital,Yulin,Guangxi 537000,China;Yulin Orthopedics Hospital of Chinese and Western Medicine,Yulin,Guangxi 537000,China)

机构地区：[1]玉林市红十字会医院骨科,广西玉林537000 [2]玉林市中西医结合骨科医院,广西玉林537000

出　　处：《颈腰痛杂志》2021年第3期318-321,325,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：玉林市科学研究与技术开发计划项目(NO:玉市科20201607)。

摘　　要：目的分析颈前路椎体次全切除减压融合术(anterior cervical corpectomy decompression and fusion,ACCF)精准治疗多节段脊髓型颈椎病的临床疗效及手术策略。方法回顾性分析2016年5月~2018年7月本院治疗的36例三节段脊髓型颈椎病患者的临床资料。根据具体的病理特性分两组,A组20例行ACCF联合Zero-p固定术,B组16例行两椎体ACCF术治疗。采用JOA评价评价临床效果,根据颈椎Cobb角、椎间隙高度变化评价矫形效果。结果所有患者均获随访,A组平均随访(18.6±7.3)个月,B组(20.1±8.2)个月。两组手术时间、术中出血量有显著性差异(P<0.05),A组优于B组。两组术后1个月和末次随访的JOA评分、颈椎Cobb角及椎间隙高度均较术前显著改善(P<0.05),术后JOA评分、颈椎Cobb角及椎间隙高度差异无统计学意义(P>0.05)。结论ACCF联合Zero-p固定术与两椎体ACCF术治疗多节段脊髓型颈椎病均可获得良好的疗效,前者手术时间短、创伤小。术中应严格把握手术适应证,根据具体的病理特性,精准选择手术方式。Objective To investigate the clinical outcomes of anterior cervical corpectomy decompression and fusion(ACCF)in the precise treatment of multilevel cervical spondylotic myelopathy.Methods From May 2016 to July 2017,36 patients with three-level cervical spondylotic myelopathy were enrolled.The patients were divided into two groups according to specific pathological characteristics.Of which,20 cases were treated by ACCF combined with Zero-p fixation(group A),the other 16 cases were treated by two-segment ACCF(group B).The clinical outcome was assessed by JOA score.The orthopaedic effect was investigated according to cervical Cobb angle and intervertebral space height.Results All patients were followed up for an average of(18.6±7.3)months in group A,and(20.1±8.2)months in group B.The operation time,intraoperative blood loss in group A were significantly better than those in group B(P<0.05).The JOA score,Cobb angle and intervertebral space height at 1 month after operation and last follow-up were significantly improved compared with preoperation(P<0.05).But the differences in postoperative indicators between the two groups were not statistically significant(P>0.05).Conclusion ACCF combined with Zero-p fixation and two-segment ACCF can achieve good results in treating multilevel cervical spondylotic myelopathy.To ensure the efficacy,intraoperative indications should be strictly grasped,and surgical Methods should be accurately selected according to specific pathological characteristics.

关 键 词：颈前路椎体次全切除减压融合术 零切迹融合器 多节段脊髓型颈椎病 

分 类 号：R687.3[医药卫生—骨科学]