脊髓型颈椎病前路术后邻近节段退变性疾病的手术治疗  

Surgical treatment of degenerative diseases in adjacent segments after anterior cervical myelopathy

作　　者：刘涛[1] 支中正 王英杰 李富平 康健 徐广辉 侯铁胜[1] 吴德升[2] LIU Tao;ZHI Zhong-zheng;WANG Ying-jie;LI Fu-ping;KANG Jian;XU Guang-hui;HOU Tie-sheng;WU De-sheng(Tongji University Affiliated Shanghai Fourth People’s Hospital,Shanghai,200434,China;Tongji University Affiliated Shanghai Dongfang Hospital,Shanghai,200120,China)

机构地区：[1]同济大学附属上海市第四人民医院,上海200434 [2]同济大学附属上海市东方医院,上海200120

出　　处：《颈腰痛杂志》2023年第3期382-385,389,共5页The Journal of Cervicodynia and Lumbodynia

基　　金：上海市第四人民医院人才助推计划项目(编号:SY-XKZT-2019-3002);上海市虹口区卫生健康委员会课题资助项目(编号:虹卫2102-15);上海市第四人民医院人才助推计划项目(编号:SY-XKZT-2021-3001)。

摘　　要：目的探讨单节段颈椎前路间盘切除减压融合术(anterior cervical discectomy and fusion,ACDF)治疗脊髓型颈椎病(cervical spondylotic myelopathy,CSM)前路术后邻近节段退变性疾病(adjacent segmental degenerative diseases,ASD)的临床疗效,及其对下颈椎矢状位平衡的影响。方法回顾性分析2010年1月~2019年12月于上海市第四人民医院脊柱外科因颈前路术后ASD再次行单节段ACDF手术的CSM患者56例,依据首次前路手术方案,分为ACDF组(首次行ACDF手术)和ACCF组(首次行ACCF手术)。对两组患者翻修术前及术后12个月时的颈痛和上肢痛VAS评分、颈椎JOA评分和颈椎功能障碍指数(neck disability index,NDI)进行评价,同时测量C_(2-7)Cobb角、颈椎矢状面轴向垂直距离(C_(2-7)sagittal vertical axis,C_(2-7)SVA)和T_(1)倾斜角(T_(1)slope,T1S)。结果与翻修术前相比,两组患者术后12个月的颈痛VAS评分、NDI指数均显著降低(P<0.05)、JOA评分显著增加(P<0.05),且C_(2-7)Cobb角、T_(1)S和C_(2-7)SVA均显著减少(P<0.05);双上肢VAS评分未见显著变化(P>0.05)。结论单节段ACDF手术治疗CSM患者两种前路术后ASD的疗效明确,但翻修手术会改变下颈椎矢状位平衡,表现为颈椎生理曲度减小、序列变直、头颅重心后移。Objective To explore the clinical effect and the balance of lower cervical spine after single-segment anterior cervical discectomy and fusion(ACDF)in the treatment of adjacent segment degenerative disease(ASD)after anterior surgery(ACDF/ACCF)of cervical spondylotic myelopathy(CSM).Methods Fifty-six patients with CSM who underwent single-segment ACDF surgery again for ASD after anterior cervical surgery from January 2010 to December 2019 in the Department of Spine Surgery,Shanghai Fourth People’s Hospital were retrospectively analyzed and divided into ACDF group(first ACDF surgery)and ACCF group(first ACCF surgery)according to the first anterior surgery protocol.Neck pain and upper limb pain VAS scores,cervical JOA scores and cervical disability index(NDI)were evaluated before and 12 months after revision surgery in both groups,and C_(2-7)Cobb angle,C_(2-7)sagittal vertical axis(C_(2-7)SVA)and T_(1) slope(T_(1)S)were measured.Results Compared with the pre-revision period,the neck pain VAS score and NDI index were significantly lower(P<0.05)and the JOA score was significantly higher(P<0.05),and the C_(2-7)Cobb angle,T_(1)S and C_(2-7)SVA were significantly lower(P<0.05)in both groups 12 months after surgery;no significant changes were seen in the VAS scores of both upper limbs(P>0.05).Conclusion Single-segment ACDF surgery hasperfect effects on ASD after anterior approaches for CSM.However,revision surgery may change the sagittal balance of the lower cervical spine,performed as a decreased curvature of the cervical spine,a straightened alignment,and a shift of the center of gravity of head.

关 键 词：脊髓型颈椎病 邻近节段退变病 翻修手术 矢状位平衡 

分 类 号：R681.5[医药卫生—骨科学] R687.3[医药卫生—外科学]