摘要
[目的]比较前路颈椎体次全切除植骨融合术(anterior cervical corpectomy with fusion,ACCF)和前路颈椎间盘切除植骨融合术(anterior cervical discectomy with fusion,ACDF)两种术式在相邻两节段脊髓型颈椎病手术治疗中的应用。[方法]对2006年6月～2010年3月相邻两节段脊髓型颈椎病手术治疗患者的临床资料和影像学资料进行回顾性研究,共67例符合研究要求,其中ACCF 36例,ACDF 31例。评估、比较两组的围手术期指标(住院日、出血量、手术时间、取骨处并发症以及颈部并发症)、临床疗效指标(脊髓神经功能JOA评分、颈部及上肢疼痛VAS评分)及影像学指标(颈椎矢状曲度情况、颈椎前凸角度、颈椎活动度、融合节段活动度、融合节段前后缘高度及融合率)。[结果]平均随访时间ACCF(28.96±13.21)个月,ACDF(26.81±11.02)个月。两组间比较时,手术时间及术中出血量ACCF比ACDF多,并发症发生率更高,有显著性差异,而术后随访时颈椎前凸角度以及融合节段高度ACCF比ACDF低,有显著性差异,其他参数无显著性差异。但组内比较时,术后即刻与术前、术后6周时与术后即刻有显著性差异,末次随访时与术后6周时ACCF融合节段后缘高度相比有显著性差异,其余指标及ACDF组内无显著性差异。[结论]ACCF、ACDF均是治疗相邻两节段脊髓型颈椎病的有效术式,但ACDF在手术时间、出血量、并发症发生率以及一些影像学指标上有显著性优势,具体的手术方式选择应根据脊髓受压迫需要减压的部位而定。
[Objective] To compare the outcomes of patients treated with either anterior cervical corpectomy with fusion （ACCF） or anterior cervical discectomy with fusion （ACDF） for two - adjacent - level cervical spondylotie myelopathy. [ Meth- ods ] The case histories of 67 patients underwent surgical treatment for two - adjacent - level cervical spondylotic myelopathy from June 2006 to March 2010 were retrospectively reviewed. There were 36 with a single - level corpectomy and 31 with a two - level ACDF. The following were analyzed ： （ 1 ） perioperative parameters （ hospital stays, bleeding amounts, operative times, complications）, （2） clinical parameters （Japanese Orthopedic Association scores, Visual Analog Scale scores for neck and arm pain）, and （3） radiologic parameters （sagittal alignment, cervical lordosis, total cervical range of motion, segmental range of motion, anterior and posterior body height for the fused levels, fusion rate） . [ Results ] The mean durations of follow - up were 28.96 ±13.21 （ACCF） and 26. 81±11.02 （ACDF） months. Of these above parameters, operative time, bleeding amount and complication rates were significantly greater in the ACCF group, whereas postoperative cervical lordosis and segmental height were significantly lower in the ACCF group postoperatively. However, other parameters were not significantly different between the 2 groups. All radiologie parameters occurred significantly more during the first 6 weeks after surgery than after 6 weeks. The loss of posterior body height for the fused levels significantly progressed after 6 weeks in Group ACCF, with no differences in Group ACDF. [ Conclusion] Our data suggest that the two procedures yield comparable results in terms of clinical outcomes for two - adjacent -level cervical spondylotic myelopathy. However, ACDF was found to be superior to ACCF in terms of operation times, bleeding amounts, complication rates and some radiologic resuhs. The decision to perform either ACCF or ACDF is determin
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2012年第21期1931-1934,共4页
Orthopedic Journal of China
基金
重庆市卫生局医学科研项目(编号:2008-2-314)
关键词
脊髓型颈椎病
椎间盘切除
椎体次全切除
比较
cervical spondylotic myelopathy, discectomy, corpectomy, comparision
