颈椎管狭窄ACCF与颈后路椎管扩大减压的效果对比  

Comparison of the effects of anterior cervical corpectomy and fusion versus posterior cervical decompression for cervical spinal stenosis

作　　者：郑朋飞 邱锴[2] 张宾 梁晓飞 ZHENG Peng-fei;QIU Kai;ZHANG Bin;LIANG Xiao-fei

机构地区：[1]郑州阳城医院神经外科,河南郑州450000 [2]郑州大学第一附属医院神经外科,河南郑州450000 [3]郑州阳城医院脊柱外科,河南郑州450000

出　　处：《中国疗养医学》2024年第8期108-112,共5页Chinese Journal of Convalescent Medicine

摘　　要：目的探究次全切除减压融合术(ACCF)与颈后路椎管扩大减压术在颈椎管狭窄(CSS)患者治疗中的应用价值。方法选取2021年1月至2023年8月郑州阳城医院收治的60例CSS患者,采用电脑随机法分为两组,每组各30例。次全切组行ACCF术,减压组行颈后路椎管扩大减压术。比较两组围手术期指标、手术前后炎症因子[单核细胞趋化因子-1(MCP-1)、白细胞介素(IL-6、IL-1β)]、颈椎生物力学特征(Cobb角、椎管横截面积、颈椎曲度)、颈椎功能(NDI评分)、疼痛程度(VAS评分)及并发症情况。结果次全切组手术时间、引流管留置时间与住院时间短于减压组,术中出血量低于减压组(P<0.05);术后1 d、3 d次全切组MCP-1、IL-6、IL-1β水平低于减压组(P<0.05);术后3个月、6个月次全切组Cobb角、椎管横截面积、颈椎曲度均高于减压组(P<0.05);术后3个月、6个月两组NDI评分、VAS评分比较,差异无统计学意义(P>0.05);术后两组并发症发生率比较,差异无统计学意义(P>0.05)。结论ACCF与颈后路椎管扩大减压术均是CSS安全可靠的方案,但ACCF能优化手术流程,减轻炎症损伤,在术后早期恢复及颈椎生物力学特征改善方面优势显著。Objective To explore the application value of anterior cervical corpectomy and fusion(ACCF)versus posterior cervical decompression in the treatment of cervical spinal stenosis(CSS).Methods A total of 60 CSS patients admitted to Zhengzhou Yangcheng Hospital from January 2021 to August 2023 were selected and randomly assigned into ACCF group(n=30)and posterior cervical decompression group(n=30)receiving corresponding surgical procedures.Perioperative indicators,inflammatory factors(monocyte chemokine-1[MCP-1],interleukin[IL-6,IL-1β]),biomechanical characteristics of the cervical spine(Cobb angle,cross-sectional area of spinal canal,curvature of cervical spine),cervical spine function(neck disability index[NDI]),degree of pain(visual analogue scale[VAS]score)before and after surgery,and the complications were compared between the two groups.Results Patients in the ACCF group had significantly shorter operation time,duration of drainage tube intubation and length of stay,and less intraoperative bleeding than those of posterior cervical decompression group(P<0.05).At 1 and 3 days postoperatively,patients in the ACCF group had significantly lower MCP-1,IL-6 and IL-1βlevels than those of posterior cervical decompression group(P<0.05).At 3 and 6 months postoperatively,patients in the ACCF group had significantly higher Cobb angle,cross-sectional area of spinal canal and curvature of cervical spine than those of posterior cervical decompression group(P<0.05).No significant differences in the NDI and VAS score at 3 and 6 months postoperatively were detected between groups(P>0.05).There was no significant difference in the incidence of postoperative complications between groups(P>0.05).Conclusion Both ACCF and posterior cervical decompression are safe and reliable options for CSS,but ACCF can optimize the surgical process,reduce inflammation and injury,and has significant advantages in early postoperative recovery and improvement of cervical biomechanical characteristics.

关 键 词：颈椎管狭窄 椎管扩大减压术 减压融合术 炎症 颈椎生物力学 颈椎功能 疼痛程度 

分 类 号：R687.3[医药卫生—骨科学]