显微镜辅助下前路颈椎间盘切除融合术治疗骨性压迫致神经根型颈椎病的临床研究  

A clinical study of microscope-assisted anterior cervical discectomy and fusion for treatmen to fcervical spondylotic radiculopathy caused by bone compression

作　　者：李亚伟 梅伟[2] 张振辉[2] 李文祥 LI Yawei;MEI Wei;ZHANG Zhenhui;LI Wenxiang(The Second Clinical Medical College of Henan University of Chinese Medicine,Zhengzhou 450002,Henan,China;Zhengzhou Orthopedics Hospital,Zhengzhou 450052,Henan,China;Zhoukou Orthopaedic Hospital,Zhoukou 466000,Henan,China)

机构地区：[1]河南中医药大学第二临床医学院,河南郑州450002 [2]郑州市骨科医院,河南郑州450052 [3]周口骨科医院,河南周口466000

出　　处：《中医正骨》2022年第10期18-26,共9页The Journal of Traditional Chinese Orthopedics and Traumatology

摘　　要：目的:观察显微镜辅助下前路颈椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)治疗骨性压迫致神经根型颈椎病的临床疗效和安全性。方法:回顾性分析46例骨性压迫致神经根型颈椎病患者的病例资料,其中采用显微镜辅助下ACDF(术中行精细化减压)治疗22例(显微镜辅助下ACDF组),采用前路颈椎体次全切除融合术(anterior cervical corpectomy and fusion,ACCF)治疗24例(ACCF组)。比较2组患者的术中出血量、手术时间、颈椎疼痛视觉模拟量表(visual analogue scale,VAS)评分、日本骨科学会(Japanese Orthopaedic Association,JOA)脊髓型颈椎病评分、椎间融合率及并发症发生率。结果:①一般结果。显微镜辅助下ACDF组患者术中出血量少于ACCF组[(41.18±11.00)mL,(91.42±21.31)mL,t=-9.906,P=0.000],手术时间短于ACCF组[(59.59±8.71)min,(79.79±17.45)min,t=-4.896,P=0.000]。②颈椎疼痛VAS评分。时间因素和分组因素存在交互效应(F=3.689,P=0.036);2组患者的颈椎疼痛VAS评分总体比较,组间差异有统计学意义,即存在分组效应(F=4.564,P=0.038);手术前后不同时间点颈椎疼痛VAS评分的差异有统计学意义,即存在时间效应(F=278.765,P=0.000);2组患者颈椎疼痛VAS评分随时间变化均呈下降趋势,但2组的下降趋势不完全一致(F=165.747,P=0.000;F=210.692,P=0.000);术前、术后1个月,2组患者颈椎疼痛VAS评分比较,组间差异均无统计学意义[(3.95±0.79)分,(4.00±0.85)分,t=-0.208,P=0.836;(0.75±0.44)分,(0.80±0.40)分,t=-0.474,P=0.638];术后1周,显微镜辅助下ACDF组患者颈椎疼痛VAS评分低于ACCF组[(2.05±0.70)分,(2.75±0.75)分,t=-3.222,P=0.002]。③JOA脊髓型颈椎病评分。时间因素和分组因素存在交互效应(F=3.863,P=0.021);2组患者的JOA脊髓型颈椎病评分总体比较,组间差异有统计学意义,即存在分组效应(F=6.276,P=0.016);手术前后不同时间点JOA脊髓型颈椎病评分的差异有统计学意义,即存在时间效应(F=5Objective:To investigate the clinical efficacy and safety of microscope-assisted anterior cervical discectomy and fusion(ACDF)for treatment of cervical spondylotic radiculopathy(CSR)caused by bone compression.Methods:The medical records of 46 patients with CSR caused by bone compression were analyzed retrospectively.Twenty-two patients were treated with microscope-assisted ACDF(microscope-assisted ACDF group)and 24 ones with anterior cervical corpectomy and fusion(ACCF)(ACCF group).The intraoperative blood loss,operative time,cervical pain visual analogue scale(VAS)score,Japanese Orthopaedic Association(JOA)score for assessing cervical spondylotic myelopathy(CSM),intervertebral fusion rate and complications were compared between the 2 groups.Results:①The intraoperative blood loss was less and the operative time was shorter in microscope-assisted ACDF group compared to ACCF group(41.18±11.00 vs 91.42±21.31 mL,t=-9.906,P=0.000;59.59±8.71 vs 79.79±17.45 minutes,t=-4.896,P=0.000).②There was interaction between time factor and group factor in cervical pain VAS score(F=3.689,P=0.036).There was statistical difference in cervical pain VAS scores between the 2 groups in general,in other words,there was group effect(F=4.564,P=0.038).There was statistical difference in cervical pain VAS scores between different timepoints before and after the surgery,in other words,there was time effect(F=278.765,P=0.00).The cervical pain VAS scores presented a downward trend over time in the 2 groups,while the 2 groups were inconsistent with each other in the variation tendency(F=165.747,P=0.000;F=210.692,P=0.000).There was no statistical difference in cervical pain VAS scores between the 2 groups before the surgery and at postsurgical month 1(3.95±0.79 vs 4.00±0.85 points,t=-0.208,P=0.836;0.75±0.44 vs 0.80±0.40 points,t=-0.474,P=0.638),while the cervical pain VAS scores decreased in microscope-assisted ACDF group compared to ACCF group at postsurgical week 1(2.05±0.70 vs 2.75±0.75 points,t=-3.222,P=0.002).③There was intera

关 键 词：颈椎病 脊柱骨赘病 椎间盘切除术 脊柱融合术 手术显微镜 临床试验 

分 类 号：R687.3[医药卫生—骨科学]