摘要
目的分析颈前路椎体次全切除减压融合术(ACCF)联合颈前路椎间盘切除椎间植骨融合内固定术(ACDF)对多节段脊髓型颈椎病(MCSM)患者日本骨科学会(JOA)及颈椎功能障碍指数(NDI)评分的影响。方法选取2019年1月至2020年5月收治的80例MCSM患者为研究对象,按照随机数字表法将其分为对照组[n=40,后路单开门椎管扩大成形术(LAMP)]和观察组(n=40,ACCF联合ACDF)。比较两组的治疗效果。结果两组的手术时间无显著差异(P>0.05);观察组的术中出血量、住院时间、术后3个月视觉模拟疼痛量表(VAS)评分均优于对照组,差异具有统计学意义(P<0.05)。治疗前,两组的JOA、NDI评分、颈椎前凸角、T1倾斜角、C2~C7活动度无显著差异(P>0.05);随访1年后,观察组的JOA、NDI评分、颈椎前凸角、T1倾斜角、C2~C7活动度均优于对照组,差异具有统计学意义(P<0.05)。术前,两组的白细胞分化抗原4阳性(CD4^(+))、白细胞分化抗原8阳性(CD8^(+))、CD4^(+)/CD8^(+)无显著差异(P>0.05);术后,观察组的CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)均优于对照组,差异具有统计学意义(P<0.05)。两组的术后并发症总发生率无显著差异(P>0.05)。结论ACCF联合ACDF治疗MCSM的手术效果较优,患者颈椎稳定性好,且对免疫功能影响小,利于促进患者康复。
Objective To analyze the effects of anterior discectomy fusion(ACCF)combined with anterior cervical decompression and fusion(ACDF)on Japanese Orthopaedic Association(JOA)and Neck Disability Index(NDI)scores in patients with multilevel cervical spondylotic myelopathy(MCSM).Methods Eighty patients with MCSM treated from January 2019 to May 2020 were selected as the study objects and divided into control group[n=40,posterior open-door laminoplasty(LAMP)]and observation group(n=40,ACCF combined with ACDF).The therapeutic effects of the two groups were compared.Results There was no significant difference in operation time between the two groups(P>0.05);the intraoperative blood loss,hospital stay,Visual Analogue Scale(VAS)score at 3 months after operation in the observation group were better than those in the control group,and the differences were statistically significant(P<0.05).Before treatment,there were no significant differences in JOA,NDI scores,cervical lordosis angle,T1 inclination angle and C2-C7 motion between the two groups(P>0.05);after 1 year of follow-up,the JOA,NDI scores,cervical lordosis angle,T1 inclination angle and C2-C7 motion in the observation group were better than those in the control group,and the differences were statistically significant(P<0.05).Before surgery,there were no significant differences in cluster of differentiation 4 positive(CD4^(+)),cluster of differentiation 8 positive(CD8^(+))and CD4^(+)/CD8^(+)between the two groups(P>0.05);after surgery,CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)in the observation group were better than those in the control group,and the differences were statistically significant(P<0.05).There was no significant diference in the total incidence of postoperative complications between the two groups(P>0.05).Conclusion ACCF combined with ACDF in the treatment of MCSM has a better surgical effect,the patients'cervical spine stability is good,and the influence on immune function is small,which is conducive to promoting the patient recovery.
作者
陈信
杜佳泷
邹志余
CHEN Xin;DU Jialong;ZOU Zhiyu(Ankang Hospital of Traditional Chinese Medicine,Ankang 725000,China)
出处
《临床医学研究与实践》
2023年第14期34-37,共4页
Clinical Research and Practice
