摘要
目的对比分析双节段前路颈椎间盘切除融合术(anterior cervical discectomy and fusion,ACDF)与单节段前路椎体次全切钛网植骨融合术(anterior cervical corpectomy and fusion,ACCF)治疗邻近双节段脊髓型颈椎病的临床疗效。方法回顾性分析2009年6月至2014年3月因邻近双节段脊髓型颈椎病在我院行ACDF和ACCF手术的51例患者。27例患者行ACDF术(男性16例,女性11例),24例患者行ACCF术(男性13例,女性11例)。记录患者一般资料、手术相关参数、并发症发生率、融合率等数据;在术前和术后随访时进行疼痛视觉模拟评分(visual analogue scale,VAS)、颈椎功能障碍指数(neck disability index,NDI)、日本矫形外科学会评分(Japanese orthopaedic association,JOA)及测量颈椎Cobb角。结果 ACDF组平均随访时间为(30.2±10.5)个月,手术时间为(83.5±15.7)min,术中出血为(135.5±21.4)mL,术后并发症发生率为14.8%,术后3个月融合率为88.9%。术后3个月及末次随访的VAS评分、NDI指数、JOA评分、Cobb角均显著优于术前。ACCF组平均随访时间为(28.3±12.1)个月,手术时间为(118.3±20.9)min,术中出血为(329.3±70.2)mL,术后并发症发生率为16.7%,术后3个月融合率为91.7%。术后3个月及末次随访的VAS评分、NDI指数、JOA评分、Cobb角均显著优于术前。ACDF组的术中失血量、手术时间以及术后Cobb角均显著优于ACCF手术。结论双节段ACDF手术和单节段ACCF手术具有相似的临床效果,均能显著改善症状和恢复神经功能,不过ACDF手术的术中失血量、手术时间以及颈椎曲度的恢复均优于ACCF手术。因此在邻近双节段脊髓型颈椎病的治疗上,双节段ACDF手术在一定程度上优于单节段ACCF手术。
Objective To compare the clinical outcomes between anterior cervical discectomy and fusion（ACDF）and anterior cervical corpectomy and fusion（ACCF）in treating the adjacent two segments cervical spondylotic myelopathy.Methods 51 patients with cervical spondylotic myelopathy who underwent ACDF and ACCF between June 2009 and March 2014 were enrolled in this study.27 patients underwent ACDF and 24 patients underwent ACCF.We recorded operative time,blood loss,length of hospital stay,complications rates and fusion rates.The JOA score,VAS pain score,NDI index and Cobb angle data were obtained.Results In ACDF group,the mean follow-up was（30.2±10.5）months.The average operation time was（83.5±15.7）min.The average operative blood loss was（135.5±21.4）mL.The complications rates was 14.8%.The fusion rates was 88.9%.The average postoperative JOA score,VAS pain score,NDI index and Cobb angle improved significantly.In ACCF group,the mean follow-up was（28.3±12.1）months.The average operation time was（118.3±20.9）min,the average operative blood loss was（329.3±70.2）mL,the complications rates was 16.7%,the fusion rates was 91.7%.The average postoperative JOA score,VAS pain score,NDI index and Cobb angle improved significantly.No significant differences were found between 2groups with respect to VAS pain score,NDI index and JOA score.The operation time、operative blood loss and postoperative Cobb angle of ACDF group was better than that of ACCF group.Conclusion 2-level ACDF has better outcomes compared with 1-level ACCF in treating adjacent two segments cervical spondylotic myelopathy.It has shorter operation time,less bleeding and better Cobb angle.
出处
《实用骨科杂志》
2017年第2期100-104,共5页
Journal of Practical Orthopaedics
基金
陕西省科技厅面上项目(2014JM4115)
陕西省中医药管理局项目(13-LC101)
咸阳市脊椎退变疾病创新团队
