多节段脊髓型颈椎病间盘切除与椎体次全切融合比较  

Anterior cervical discetomy and fusion versus anterior cervical corpectomy and fusion for multilevel cervical myelopathy

作　　者：陈光 刘涛 王冰一 周晓永 CHEN Guang;LIU Tao;WANG Bing-yi;ZHOU Xiao-yong(Second Department of Orthopaedics,People's Hospital of Henan Province,Zhengzhou University,Zhengzhou 450003,Henan,China)

机构地区：[1]河南省人民医院(郑州大学人民医院)骨二科,河南郑州450003

出　　处：《中国矫形外科杂志》2025年第5期404-409,共6页Orthopedic Journal of China

基　　金：河南省医学科技攻关计划项目(编号:SB201901081)。

摘　　要：[目的]比较颈椎前路椎间盘切除椎间植骨融合术(anterior cervical discetomy and fusion,ACDF)与椎体次全切减压融合术(anterior cervical corpectomy with fusion,ACCF)治疗多节段脊髓型颈椎病(cervical spondylotic myelopathy,MCSM)的临床疗效。[方法]回顾性分析102例在本院接受治疗的MCSM患者的临床资料,根据医患沟通结果,51例采用ACDF术,另外51例采用ACCF术。比较两组围手术期、随访和影像资料。[结果]ACDF组在手术时间[(125.8±12.6)min vs(136.8±13.7)min,P<0.001]、术中失血量[(185.6±18.6)mL vs(206.7±21.2)mL,P<0.001]、住院时间[(10.6±1.1)d vs(12.7±1.3)d,P<0.001]均显著优于AC-CF组。随时间推移,两组患者NDI评分、JOA评分及锥体束征均明显改善(P<0.05),ACDF组术后6个月和末次随访JOA评分[(13.6±1.6)vs(12.1±1.3),P<0.001;(15.1±1.6)vs(14.4±1.6),P=0.029],以及末次随访NDI评分[(10.8±1.1)vs 13.6±1.3),P<0.001]均显著优于ACCF组。影像学方面,与术前相比,末次随访时两组颈椎前凸角、C2~7矢状垂直轴(sagittal vertical axis,SVA)、T1倾斜角及最小椎管矢状径均显著改善(P<0.05),末次随访时,ACDF组颈椎前凸角[(28.8±2.9)°vs(5.1±2.5)°,P<0.001]、SVA[(11.4±1.2)mmvs(15.4±1.6)mm,P<0.001]和T1倾斜角[(25.1±2.5)°vs(28.3±2.9)°,P<0.001]均显著优于ACCF组。[结论]与ACCF相比,ACDF治疗MCSM可有效减少手术创伤,取得更好临床治疗结果。[Objective]To compare of clinical consequences of anterior cervical discetomy and fusion(ACDF)versus anterior cervicalcorpectomy and fusion(ACCF)for multi-segment cervical spondylotic myelopathy(MCSM).[Methods]A retrospective study was conductedon 102 patients who had MCSM treated surgically in our hospital.According to the results of doctor-patient communication,51 patients re-ceived ACDF,while the other 51 received ACCF.The perioperative,follow-up and imaging data of the two groups were compared.[Results]The ACDF group proved significantly superior to the ACCF group in terms of operative time[(125.8±12.6)min vs(136.8±13.7)min,P<0.001],intraoperative blood loss[(185.6±18.6)mL vs(206.7±21.2)mL,P<0.001]and hospital stay[(10.6±1.1)days vs(12.7±1.3)days,P<0.001].With time went on,the NDI and JOA scores,as well as pyramidal tract sign significantly improved in both groups(P<0.05).However,the ACDF group proved significantly better than the ACCF group regarding JOA score 6 months after surgery and at the last follow-up[(13.6±1.6)vs(12.1±1.3),P<0.001;(15.1±1.6)vs(14.4±1.6),P=0.029],and NID score at the latest follow-up[(10.8±1.1)vs(13.6±1.3),P<0.001].As for imaging,the cervical lordotic angle,C2~7 sagittal vertical axis(SVA),T1 slope and minimum sagittal diameter of spinal canalsignificantly improved in both groups at the last follow-up compared with those preoperatively(P<0.05).The ACDF group was also significant-ly better than the ACCF group in terms of cervical lordotic angle[(28.8±2.9)°vs(5.1±2.5)°,P<0.001],SVA[(11.4±1.2)mm vs(15.4±1.6)mm,P<0.001]and T1 slope[(25.1±2.5)°vs(28.3±2.9)°,P<0.001].[Conclusion]The ACDF does effectively reduce surgical trauma and achievebetter clinical outcomes for MCSM over the ACCF.

关 键 词：脊髓型颈椎病 椎体次全切减压融合术 颈椎前路椎间盘切除融合术 疗效 颈椎功能 

分 类 号：R681.55[医药卫生—骨科学]