椎动脉型颈椎病行颈前路椎间盘切除减压植骨融合术的疗效分析  

Curative effect analysis of anterior cervical discectomy and fusion in patients with cervical spondylosis of vertebral artery type

作　　者：艾义翔 刘俭涛 郝定均[1] 龚禧 朱以涵 李幸橼 张熙伟 王考 孙佳俊 张淑媛 AI Yi-xiang;LIU Jian-tao;HAO Ding-jun;GONG Xi;ZHU Yi-han;LI Xing-yuan;ZHANG Xi-wei;WANG Kao;SUN Jia-jun;ZHANG Shu-yuan(Department of Spine Surgery,Honghui Hospital Affiliated to Xi'an Jiaotong University,Xi'an 710054,Shaanxi,China;Department of Orthopaedics,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710054,Shaanxi,China)

机构地区：[1]西安交通大学附属红会医院脊柱外科,陕西西安710054 [2]西安交通大学第一附属医院骨科,陕西西安710061

出　　处：《中国骨伤》2024年第7期670-675,共6页China Journal of Orthopaedics and Traumatology

基　　金：国家自然科学基金重点项目(编号:81830077);陕西省重点研发计划(编号:2022GY-390);西安交通大学第一附属医院科研发展基金(编号:2020QN-36)。

摘　　要：目的:探讨颈前路椎间盘切除减压植骨融合术(anterior cervical discectomy and fusion,ACDF)治疗椎动脉型颈椎病(cervical spondylosis of vertebral artery type,CSA)的临床效果。方法:回顾性分析2020年1月至2022年1月42例CSA患者的临床资料,男25例,女17例;年龄30~74(53.9±11.0)岁。单节段病变18例,2个节段病变17例,3个节段病变7例。分别在术前和术后6个月时采用美国耳鼻咽喉头颈外科学会听力及平衡委员会评分(Committee on Hearing and Equilibrium,CHE)、颈椎功能障碍指数(neck disability index,NDI)和颈椎曲度Cobb角进行临床疗效评价。结果:42例患者均获随访,随访时间6~30(14.0±5.2)个月;手术时间95~220(160.38±36.77)min,术中出血量30~85(53.60±18.98)ml。2例术后出现轻度吞咽困难,给予雾化吸入等对症处理后均好转。CHE评分由术前(4.05±0.96)分降低至术后6个月的(2.40±0.70)分(t=12.97,P<0.05)。术后6个月38例眩晕改善,改善率90.5%。NDI评分的由术前的(34.43±8.04)分降低至术后6个月的(20.76±3.91)分(t=11.83,P<0.05)。颈椎曲度Cobb角由术前的(8.04±6.70)°提高至术后6个月的(12.42±5.23)°(t=-15.96,P<0.05)。结论:ACDF术式治疗椎动脉型颈椎病的临床疗效突出,手术通过解除骨性压迫,重建颈椎曲度,可快速缓解患者的发作性眩晕症状。但需要严格把握手术指征,明确患者眩晕原因,对保守治疗无效的CSA患者,ACDF手术可推荐使用。Objective To investigate the clinical effect of anterior cervical discectomy and fusion(ACDF)in the treatment of cervical spondylosis of vertebral artery type(CSA).Methods The clinical data of 42 patients with CSA from January 2020 to January 2022 were retrospectively analyzed.There were 25 males and 17 females,aged from 30 to 74 years old with an average of(53.9±11.0)years old.There were 18 cases with single-segment lesions,17 cases with two-segment lesions,and 7 cases with three-segment lesions.The American Academy of Otolaryngology-Head and Neck Surgery's Hearing and Balance Committee score(CHE),the Neck Disability Index(NDI)and the cervical curvature Cobb angle were recorded before surgery and after surgery at 6 months.Results All 42 ACDF patients were followed up for 6 to 30 months with an average of(14.0±5.2)months.The operative time ranged from 95 to 220 min with an average of(160.38±36.77)min,the intraoperative blood loss ranged from 30 to 85 ml with an average of(53.60±18.98)ml.Tow patients had mild postoperative dysphagia,which improved with symptomatic treatment such as nebulized inhalation.CHE score decreased from(4.05±0.96)preoperatively to(2.40±0.70)at 6 months postoperatively(t=12.97,P<0.05).The number of improved vertigo at 6 months postoperatively was 38,with an improvement rate of 90.5%.NDI score was reduced from(34.43±8.04)preoperatively to(20.76±3.91)at 6 months postopera tively (t=11.83,P<0.05). The cervical curvature Cobb angle improved from (8.04±6.70)° preoperatively to (12.42±5.23)° at 6 months postoperatively (t=-15.96,P<0.05). Conclusion The ACDF procedure has outstanding clinical efficacy in treating CSA. The operation can rapidly relieve patients' episodic vertigo symptoms by relieving bony compression and reconstructing cervical curvature. However,it is necessary to strictly grasp the indications for surgery and clarify the causes of vertigo in patients,and ACDF surgery is recommended for CSA patients for whom conservative treatment is ineffective.

关 键 词：椎动脉型颈椎病 颈前路椎间盘切除减压植骨融合术 颈性眩晕 

分 类 号：R681.5[医药卫生—骨科学]