颈椎前路椎体可控前移融合术和颈椎后路全椎板切除术治疗颈椎脊髓损伤的疗效分析  

Clinical efficacy analysis of cervical anterior controlled antedisplacement and fusion and posterior total laminectomy for treatment of cervical spinal cord injury

作　　者：王英杰 李富平 康健 陈如康 支中正 刘涛[1] 徐广辉 Wang Yingjie;Li Fuping;Kang Jian;Chen Rukang;Zhi Zhongzheng;Liu Tao;Xu Guanghui(Department of Spinal Surgery,Shanghai Fourth People’s Hospital,Tongji University School of Medicine,Shanghai 200434,China)

机构地区：[1]同济大学附属上海第四人民医院脊柱外科,上海200434

出　　处：《脊柱外科杂志》2023年第2期82-86,共5页Journal of Spinal Surgery

基　　金：虹口区卫生健康委员会医学科研课题面上项目(虹卫1902-10);虹口区卫生健康委员会医学科研课题青年项目(虹卫1903-06);上海市第四人民医院学科助推计划项目(SY-XKZT-2019-2008,SY-XKZT-2019-1004)。

摘　　要：目的 比较颈椎前路椎体可控前移融合术(ACAF)和颈椎后路全椎板切除术治疗颈椎脊髓损伤的疗效。方法 2015年3月-2021年1月,上海第四人民医院、海军军医大学长征医院收治颈椎外伤患者42例,其中20例采用ACAF治疗(ACAF组),22例采用颈椎后路全椎板切除术治疗(LAM组)。记录并比较2组术中出血量、手术时间、术后引流量、住院时间及并发症发生情况,采用美国脊髓损伤协会(ASIA)评分评价所有患者术前、术后2周及术后2年的神经功能。结果 所有手术顺利完成,所有患者随访> 24个月。2组减压节段数和手术时间差异无统计学意义(P> 0.05)。LAM组术中出血量、术后引流量和住院时间高于ACAF组,差异均有统计学意义(P <0.05)。术后24个月,2组患者神经功能ASIA评分均较术前明显改善,差异有统计学意义(P <0.05);组间差异无统计学意义(P> 0.05)。ACAF组1例发生术后并发症,LAM组4例发生术后并发症。结论 2种术式均可显著改善患者颈椎脊髓功能,且ACAF可明显减少手术出血量及住院时间,术后并发症较少。Objective To compare the clinical efficacy of cervical anterior controlled antedisplacement and fusion(ACAF)and posterior total laminectomy for treatment of cervical spinal cord injury.Methods From March 2015 to January 2021,42 patients with cervical trauma were treated in Shanghai Fourth People’s Hospital,Changzheng Hospital of Naval Medical University,of which 20 patients were treated with ACAF(ACAF group)and 22 patients were treated with posterior cervical laminectomy(LAM group).The intraoperative blood loss,operation time,postoperative drainage volume,hospital stay and complications of the 2 groups were recorded and compared.The neurological function of all the patients at pre-operation,postoperative 2 weeks and 2 years was evaluated by the American Spinal Injury Association(ASIA)score.Results All the patients were operated successfully,and followed up for more than 24 months.There was no significant difference in the number of decompressed segments and operation time between the 2 groups(P>0.05).The intraoperative blood loss,postoperative drainage volume and hospital stay in LAM group were higher than those in ACAF group,all with a statistical significance(P<0.05).At postoperative 24 months,ASIA scores of nerve function of patients in both groups were significantly improved compared with those before operation,and the difference was statistically significant(P<0.05);but there was no significant difference between the 2 groups(P>0.05).Postoperative complications occurred in 1 case in ACAF group and 4 in LAM group.Conclusions Both methods can significantly improve the spinal cord function of patients,and ACAF can significantly reduce the intraoperative blood loss and hospital stay,with fewer postoperative complications.

关 键 词：颈椎 脊髓损伤 减压术 外科 脊柱融合术 

分 类 号：R681.531[医药卫生—骨科学]