颈椎前路椎间盘切除融合术与椎体次全切除融合术治疗退行性颈椎病的对比研究  

A comparative study of anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of degenerative cervical myelopathy

作　　者：黄栋 刘永涛 辛兵 吴东迎 HUANG Dong;LIU Yongtao;XIN Bing;WU Dongying(Department of Spinal Surgery,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)

机构地区：[1]徐州医科大学附属医院脊柱外科,江苏徐州221002

出　　处：《徐州医科大学学报》2021年第11期845-848,共4页Journal of Xuzhou Medical University

摘　　要：目的比较颈椎前路椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)与颈椎前路椎体次全切除融合术(anterior cervical corpectomy and fusion,ACCF)治疗累及连续2个节段的退行性颈椎病(degenerative cervical myelopathy,DCM)的临床疗效。方法选取40例累及连续2个节段的DCM患者纳入本次回顾性研究,根据所接受手术类型将患者分为2组,即ACDF组和ACCF组。ACDF组使用聚醚醚酮(poly ether-ether-ketone,PEEK)作为椎间融合器,ACCF组使用钛网(titanium mesh cage,TMC)作为椎间融合器。比较分析2组患者围手术期指标(平均住院时间、失血量、手术时间和并发症)、临床结果指标[日本骨科协会评分(JOA)、颈部与上肢疼痛视觉模拟(VAS)评分和融合状态]。结果相比于ACDF组,ACCF组患者平均手术时间明显缩短(P<0.05),术中失血量明显增加(P<0.05),2组患者住院时间差异无统计学意义(P>0.05)。2组患者随访过程中JOA评分和颈部与上肢VAS评分较术前均明显好转(P<0.05),但2组之间比较差异无统计学意义(P>0.05)。结论2种手术方法治疗连续2个节段的DCM均取得满意效果,然而ACCF较ACDF更容易发生钛网融合器下沉,因此建议选择ACDF术式。Objective To compare the clinical effectiveness of anterior cervical discectomy and fusion(ACDF)with anterior cervical corpectomy and fusion(ACCF)for the treatment of two-adjacent-level degenerative cervical myelopathy(DCM).Methods A total of 40 patients with two-adjacent-level DCM were enrolled in the current retrospective study.According to the type of surgery,the patients were divided into two groups:an ACDF group and an ACCF group.In the ACDF group,poly ether-ether-ketone(PEEK)was used as the intervertebral cage,whereas titanium mesh cage(TMC)was selected in the ACCF group.Both groups were compared for perioperative parameters including the length of hospitalization stay,blood loss,operation time,and complications,clinical outcomes including Japanese Orthopaedic Association(JOA)scores and visual analogue scale(VAS)scores for neck and arm pain,and fusion status.Results Compared with the ACDF group,the ACCF group presented remarkably decreased average operation timer(P<0.05),and increased blood loss during operation(P<0.05).There was no difference in the length of hospitalization stay between the two groups(P>0.05).During the follow-up period,JOA score and VAS score of neck and upper limb were significantly improved in both groups compared with preoperative values(P<0.05),but there was no difference between the two groups(P>0.05).Conclusions Both surgical?options can achieve satisfactory results in the treatment of two-adjacent-level DCM.However,ACDF is suggested with respect to the possible subsidence of titanium mesh cage during ACCF.

关 键 词：颈椎前路椎体次全切除融合术 颈椎前路椎间盘切除融合术 钛网 聚醚醚酮 

分 类 号：R681.5[医药卫生—骨科学]