3D显微镜辅助下颈椎前路椎体次全切减压融合术治疗多节段颈椎病的疗效评价  

Efficacy of anterior cervical corpectomy and fusion assisted by 3D microscope in the treatment of multilevel cervical spondylosis

作　　者：胡亦劼 唐可[1,2] 钟伟洋 权正学[1,2] HU Yijie;TANG Ke;ZHONG Weiyang;QUAN Zhengxue(Department of Orthopaedics,the First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China;Orthopaedic Laboratory of Chongqing Medical University,Chongqing 400016,China)

机构地区：[1]重庆医科大学附属第一医院骨科,重庆400016 [2]重庆医科大学骨科实验室,重庆400016

出　　处：《中华骨与关节外科杂志》2025年第2期108-114,共7页Chinese Journal of Bone and Joint Surgery

基　　金：重庆市自然科学基金面上项目(CSTB2022NSCQ-MSX0070);重庆医科大学第一临床学院2019年度院级教学改革研究项目(CMER201906);重庆医科大学未来医学青年创新团队发展支持计划(W0012)。

摘　　要：目的:评价3D显微镜辅助下颈椎前路椎体次全切减压融合术(ACCF)治疗多节段颈椎病的短期临床疗效。方法:选择2021年1月至2023年4月于重庆医科大学附属第一医院行ACCF的65例多节段颈椎病患者的临床资料进行回顾性分析。其中35例患者采用3D显微镜辅助(3D显微镜辅助组),30例未采用3D显微镜辅助(传统手术组)。随访记录患者疼痛视觉模拟评分(VAS)及颈椎日本骨科协会(JOA)评分,复查颈椎标准正、侧位X线片,并于颈椎标准侧位X线片上测量C2~7 Cobb角、手术节段Cobb角、C2~7矢状面轴向距离(SVA)等影像学指标,同时观察术后并发症发生情况。结果:所有患者均完成至少12个月的随访。3D显微镜辅助组患者手术时间短于传统手术组患者(P<0.001),术中出血量少于传统手术组患者(P<0.001),而两组患者住院时间差异无统计学意义(P>0.05)。所有患者均未发生手术相关并发症。两组患者术后3 d及末次随访时疼痛VAS评分及颈椎JOA评分均优于术前(P均<0.05),末次随访时疼痛VAS评分及颈椎JOA评分均优于术后3 d(P均<0.05)。术前,两组患者C2~7 Cobb角、手术节段Cobb角及术前C2~7 SVA差异均无统计学意义(P均>0.05);末次随访时,两组患者C2~7 Cobb角、手术节段Cobb角差异均无统计学意义(P均>0.05),但3D显微镜辅助组患者C2~7 SVA小于传统手术组患者(P<0.05)。两组患者末次随访时C2~7 SVA≥40 mm的比例均较术前减少,但差异均无统计学意义(P均=1.000)。结论:3D显微镜辅助下ACCF治疗多节段颈椎病的短期疗效良好,出血量较少,手术时间较短,患者术后恢复良好,暂未发现影响颈椎稳定性的不良事件。Objective:To evaluate the short-term clinical efficacy of anterior cervical corpectomy and fusion(ACCF)assisted by 3D microscope in the treatment of multilevel cervical spondylosis.Methods:A retrospective analysis was conducted on 65 patients with multilevel cervical spondylosis who underwent ACCF at the First Affiliated Hospital of Chongqing Medical University from January 2021 to April 2023.Among them,35 patients underwent ACCF assisted by 3D microscope(3D microscope-assisted group),while 30 patients underwent traditional ACCF without 3D microscope assistance(traditional surgery group).Follow-up data included the visual analog scale(VAS)for pain and the Japanese Orthopaedic Association(JOA)score for cervical myelopathy.Standard anteroposterior and lateral cervical X-rays were reviewed.Radiographic parameters,including the C2-7 Cobb angle,surgical segment Cobb angle,and C2-7 sagittal vertical axis(SVA),were measured on standard lateral cervical X-rays.Postoperative complications were also observed.Results:All patients were followed up for at least 12 months.The 3D microscope-assisted group had shorter operation time(P<0.001)and less intraoperative blood loss(P<0.001)compared to the traditional surgery group,while there was no significant difference in hospital stay between the two groups(P>0.05).No surgery-related complications occurred in any patient.Both groups showed significant improvements in pain VAS and JOA score at 3 days postoperatively and at the final follow-up compared to preoperatively(all P<0.05),and the pain VAS and JOA score at the final follow-up were also significantly better than those at 3 days postoperatively(all P<0.05).At the final follow-up,the C2-7 SVA in the 3D microscope-assisted group was significantly smaller than that in the traditional surgery group(P<0.05).There were no significant differences in C2-7 Cobb angle,surgical segment Cobb angle,or preoperative C2-7 SVA between the two groups either preoperatively or at the final follow-up(all P<0.05).The proportion of patients with C2-

关 键 词：3D显微镜 前路颈椎椎体次全切减压融合术 多节段颈椎病 

分 类 号：R681.5[医药卫生—骨科学]