多节段脊髓型颈椎病两种减压融合术的比较  

Comparison of two anterior cervical decompression and fusion procedures for multi-segment cervical spondylotic myelopa-thy

作　　者：叶福标[1] 尹晓明[1] 林飞跃[1] 徐杨[1] YE Fu-biao;YIN Xiao-ming;LIN Fei-yue;XU Yang(Department of Orthopedics,Fujian Provincial Hospital,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院骨科,福建福州350001

出　　处：《中国矫形外科杂志》2022年第7期608-613,共6页Orthopedic Journal of China

摘　　要：[目的]比较前路颈椎体切除融合术(anterior cervical corpectomy and fusion,ACCF)联合前路颈椎间盘切除融合(anterior cervical discectomy and fusion,ACDF)与多节段单纯ACDF治疗多节段脊髓型颈病(cervical spondylotic myelopathy,CSM)的临床效果.[方法]回顾性分析2015年8月—2019年8月前路减压融合治疗CSM 86例患者的临床资料.依据术前影像病变程度,21例采用联合术式(单节段ACCF+单节段ACDF),65例采用多节段单纯ACDF术.比较两组围手术期、随访结果与影像资料.[结果]联合组术中显著失血量多于ACDF组(P<0.05),但两组手术时间、早期并发症发生率、住院时间的差异均无统计学意义(P>0.05).术前联合组深反射评级、病理反射评级均显著重于ACDF组(P<0.05),与术前相比,术后两组患者深反射评级、病理反射评级、VAS评分和NDI评分均显著改善(P<0.05).术后联合组患者的深反射评级、病理反射评级均显著优于ACDF组(P<0.05).相应时间点,两组间VAS、ODI评分的差异均无统计学意义(P>0.05).影像方面,与术前相比,末次随访时两组患者CL、SCA、C2-7 SVA均显著改善(P<0.05).术前两组CL、SVA的差异均无统计学意义(P>0.05),联合组SCA显著小于ACDF组(P<0.05),末次随访时,两组间CL、SCA、SVA的差异均无统计学意义(P>0.05).[结论]对于部分长节段ACDF手术无法获得充分减压的多节段CSM患者,联合减压植骨融合术是一个安全而又有效的替代方法,可避免长节段ACCF的潜在并发症.[Objective]To compare the clinical outcomes of anterior cervical corpectomy and fusion(ACCF)combined with anterior cervical discectomy and fusion(ACDF)versus multi-segment mere ACDF for multi-segment cervical spondylotic myelopathy(CSM).[Methods]A retrospective study was conducted on 86 patients who underwent anterior decompression and fusion for multi-segment CSM in our hospital from August 2015 to August 2019.Of them,21 patients received combined procedures(single-segment ACCF+ACDF),while the remaining 65 patients had multi-segment mere ACDFs performed.The perioperative,follow-up and imaging data were compared between the two groups.[Results]The combined group had significantly greater intraoperative blood loss than the ACDF group(P<0.05),but there was no significant difference in the operation time,the incidence of early complications,and hospital stay between the two groups(P>0.05).Before operation,the deep reflex scale and pathological reflex grade was much serious in the combined group than those in the ACDF group(P<0.05).Compared with pre-operatively,the deep reflex scale,pathological reflex grade,VAS score and NDI score improved significantly in both groups postoperatively(P<0.05).At corresponding time points,the deep reflex scale and pathological reflex grade became much better in the combined group than in the ACDF group(P<0.05),whereas no significant difference was noted in VAS and NDI scores between the two groups(P>0.05).With respect to imaging assessment,no differences in CL and SVA was found between two groups(P>0.05),but SCA was much less in the combined group than that in the ACDF group preoperatively(P<0.05),which all significantly improved at the last follow-up(P<0.05),and no significant difference was found between two groups(P>0.05).[Conclusion]For multi-segment CSM,the single-segment ACCF combined with ACDF might provide sufficient decompression which multi-segment mere ACDF can not provide,is a safe and effective alternative to the long-segment ACCF to avoid the potential complications of l

关 键 词：多节段脊髓型颈椎病 前路颈椎体切除融合术 前路颈椎间盘切除融合 

分 类 号：R681.55[医药卫生—骨科学]