颈椎双节段人工间盘置换术与前路减压融合术远期疗效的比较  

Comparison of the long-term efficacy of two-level cervical artificial disc replacement and anterior cervical decompression and fusion

作　　者：张波[1] 安岩[1] 宋卿鹏 姜宇桢 Zhang Bo;An Yan;Song Qingpeng;Jiang Yuzhen(Department of Spine Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院脊柱外科,北京100035

出　　处：《中华骨科杂志》2022年第14期880-888,共9页Chinese Journal of Orthopaedics

摘　　要：目的比较双节段颈椎人工间盘置换术(cervical artificial disc replacement,CADR)与颈椎前路减压融合术(anterior cervical decompression and fusion,ACDF)治疗颈椎退行性疾病的远期疗效。方法回顾性分析2003年12月至2007年12月因颈椎退行性疾病而行双节段颈前路手术治疗15年以上患者资料。将患者按手术方式分为CADR和ACDF两组。CADR组15例,男7例、女8例;年龄(49.73±10.26)岁(范围32~70岁);混合型颈椎病3例,神经根型颈椎病5例,脊髓型颈椎病7例;C3,4、C4,5节段1例,C3,4、C5,6节段2例,C4,5、C5,6节段7例,C5,6、C6,7节段5例;术前手术节段活动度(range of motion,ROM)为9.10°±4.00°;随访时间为(189.07±13.51)个月(范围162~210个月)。ACDF组20例,男12例、女8例;年龄(52.60±8.83)岁(范围32~68岁);混合型颈椎病2例,神经根型颈椎病3例,脊髓型颈椎病15例;C3,4、C4,5节段1例,C4,5、C5,6节段15例,C5,6、C6,7节段4例;术前手术节段ROM为8.31°±5.23°;随访时间为(184.20±21.39)个月(范围156~222个月)。分别于术前及末次随访时评估两组患者日本骨科协会(Japanese Orthopaedic Association,JOA)评分、颈椎功能障碍指数(neck disability index,NDI);末次随访时评估两组患者颈椎整体ROM、手术节段ROM、邻近节段椎间盘Miyazaki分级、Odom分级及并发症。结果CADR组JOA评分由术前(13.20±2.64)分改善至末次随访时(15.93±1.22)分,JOA改善率59.44%±60.86%;NDI由术前27.60%±6.44%改善为末次随访时15.07%±9.71%,NDI下降12.53%±9.64%。ACDF组JOA评分由术前(12.93±2.46)分改善为末次随访时(15.65±1.25)分,JOA改善率60.51%±43.17%;NDI由术前30.80%±8.11%改善为末次随访时12.80%±6.31%,NDI下降18.00%±8.34%;两组患者术前及末次随访时JOA及NDI的差异无统计学意义。末次随访时颈椎整体ROM:CADR组为38.33°±12.31°,ACDF组为31.11°±8.65°;手术节段ROM:CADR组为6.51°±4.61°,ACDF组手术节段已融合而丧失活动度;两组颈椎整体ROM的差异有统�Objective To compare the long-term efficacy of two-level cervical artificial disc replacement(CADR)and anterior cervical decompression and fusion(ACDF)in the treatment of cervical degenerative diseases.Methods A retrospective analysis was performed on patients who had received two-level anterior cervical surgery for cervical degenerative diseases for more than 15 years from December 2003 to December 2007.The patients were divided into two groups:CADR and ACDF according to surgical methods.There were 15 patients in the CADR group,including 7 males and 8 females,with an average age of 49.73±10.26(range,32-70)years.Three cases of mixed cervical spondylosis,5 cases of cervical spondylotic radiculopathy,7 cases of cervical spondylotic myelopathy,including C3,4 and C4,5 level 1 case,C3,4 and C5,6 level 2 cases,C4,5 and C5,6 level 7 cases,C5,6 and C6,7 level 5 cases,operative segment range of motion(ROM)was 9.10°±4.00°.The follow-up time in the CADR group was 189.07±13.51(range,162-210)months.There were 20 patients in the ACDF group,including 12 males and 8 females,with an average age of 52.60±8.83(range,32-68)years.Two cases of mixed cervical spondylosis,3 cases of cervical spondylotic radiculopathy,15 cases of cervical spondylotic myelopathy,including C3,4 and C4,5 level 1 case,C4,5 and C5,6 level 15 cases,C5,6 and C6,7 level 4 cases,the ROM of the surgical segment was 8.31±5.23°.The mean follow-up time of ACDF group was 184.20±21.39(range,156-222)months.The Japanese Orthopaedic Association(JOA)score and neck disability index(NDI)were evaluated preoperatively and at the last follow-up.The overall ROM of the cervical spine,ROM of the surgical segment,and Miyazaki grading of the adjacent intervertebral disc,Odom score and complications of the two groups were evaluated at the last follow-up.Results In the CADR group,the JOA score improved from 13.20±2.64 preoperatively to 15.93±1.22 at last follow-up,and NDI improved from 27.60%±6.44%preoperatively to 15.07%±9.71%at last follow-up,JOA improvement rate was 59

关 键 词：颈椎 全椎间盘置换 脊柱融合术 椎间盘退行性变 

分 类 号：R687.3[医药卫生—骨科学]