摘要
目的探讨脊髓型颈椎病患者行颈前路椎体次全切除植骨融合术(anterior cervical corporectomy and fusion,ACCF)手术中保留椎体后壁横联结构的临床价值。方法回顾性分析本科于2015年3月~2021年3月行ACCF手术的脊髓型颈椎病患者60例作为研究对象,按ACCF手术方案的不同进行分组:常规ACCF手术30例,纳入常规组;保留椎体后壁横联结构的改良ACCF手术30例,纳入改良组。术后获访1年,对两组患者的围术期指标(手术时间、出血量和住院时间)、减压效果(JOA评分)、影像学指标(颈椎曲度、融合节段高度)、手术安全性和植骨融合情况进行比较。结果改良组的手术时间、术中出血量等数据均显著低于常规组(P<0.05);但两组住院时间无显著性差异(P>0.05)。两组术后共出现7例并发症,其中常规组4例(13.3%),3例为术后肩颈部疼痛,1例声音嘶哑;改良组3例(10%),均为肩颈部疼痛。上述并发症均于1~4周后自行好转。与术前相比,两组患者术后1周的JOA评分均显著改善,且术后3个月和1年的JOA评分呈持续改善趋势(P<0.05),两组间差异均无统计学意义(P>0.05)。两组患者术后的颈椎曲度、融合节段高度等影像学指标均获不同程度改善,但组间差异无统计学意义(P>0.05)。术后1年,两组患者均获得骨性融合。结论保留椎体后壁横联结构的改良ACCF手术治疗脊髓型颈椎病患者,可取得与常规ACCF手术一致的减压效果,且手术时间短、术中出血量少,减少了对椎体结构的破坏程度,手术安全可靠。
Objective To explore the clinical value of preserving the posterior wall structure of vertebral body in anterior cervical corpectomy and fusion(ACCF).Methods The clinical data of 60 patients with cervical spondylosis who underwent ACCF surgery in our department from March 2015 to March 2021 were retrospectively analyzed.They were divided into groups according to different surgical schemes of ACCF:30 patients with conventional ACCF surgery were included in the conventional group;30 cases of modified ACCF with preservation of posterior wall structure of vertebral body were included in the modified group.After one year of follow-up,the perioperative indexes(operation time,bleeding volume and hospital stay),decompression effect(JOA score),imaging indexes(cervical curvature,fusion segment height),surgical safety and bone graft fusion of the two groups were compared.Results The operation time and intraoperative bleeding volume of the improved group were significantly lower than those of the conventional group(P<0.05).However,there was no significant difference in hospital stay between the two groups(P>0.05).There were 7 postoperative complications in the two groups,including 4 cases(13.3%)in the conventional group,3 cases of postoperative shoulder and neck pain,and 1 case of hoarseness.In the improved group,3 cases(10%)suffered from shoulder and neck pain.The above complications wereimproved spontaneously after 1~4 weeks.Compared with preoperativeindexes,the JOA scores of patients in the two groups were significantly improved in the first week after operation,and the JOA scores in the third and twelfth months after operation showed a trend of continuous improvement(P<0.05).There was no significant difference between the two groups(P>0.05).The cervical curvature,fusion segment height and other imaging indexes of the two groups were improved to varying degrees,but there was no significant difference between the two groups(P>0.05).After 12 months of operation,both groups of patients obtained bone fusion.Conclusion The modified ACCF operation with the preservation of the posterior wall structure of the vertebral body can achieve the same decompression effect as the conventional ACCF operation in the treatment of cervical spondylosis,and the operation time is short,the amount of bleeding during the operation is small,the damage to the vertebral body structure is reduced,and thus the operation is safe and reliable.
作者
史凤之
吴成如
孙军战
孙国荣
蒋传海
陈然
顾庆陟
石林新
SHI Feng-zhi;WU Cheng-ru;SUN Jun-zhan;SUN Guo-rong;JIANG Chuan-hai;CHEN Ran;GU Qing-zhi;SHI Lin-xin(Department of Orthopaedics,the 901st Hospital of the Joint Service Support Force of the People’s Liberation Army,Hefei 230031,China)
出处
《颈腰痛杂志》
2023年第4期570-573,共4页
The Journal of Cervicodynia and Lumbodynia
关键词
脊髓型颈椎病
颈前路手术
椎体次全切除
植骨融合
保留椎体后壁
cervical spondylosis
anterior cervical surgery
subtotal resection of vertebral body
bone graft fusion
preservation of posterior wall of vertebral body
