摘要
目的探讨颈前路椎间盘切除椎间融合术（ACDF）治疗颈椎病的手术指征及优点。方法回顾性分析2010年1月-2013年10月采用ACDF治疗颈椎病且获得随访的患者36例。结合患者术前术后影像学资料,日本骨科协会（JOA）评分等资料分析。结果 36例患者获得随访6~25个月,平均16个月,JOA评分：术前平均（10.67±2.66）分,术后3个月平均（13.47±2.06）分,术后6个月平均（14.11±1.56）分,术后12个月平均（14.97±1.78）分。术中患者均未出现脊髓神经损伤,无食道、气管损伤,无喉上神经喉返神经损伤。术后吞咽困难明显减轻时间为3~5 d者8例,5~7 d者6例,3周者10例,1个月后36例患者吞咽困难全部消失。随访期间无患者出现钛网下沉、移位或钛板断裂。结论 ACDF适用于解除退变的椎间盘对脊髓和（或）神经根的压迫,尤其适用于不伴有僵硬性后凸畸形,不伴有多节段后纵韧带骨化,且对脊髓的压迫位于椎间盘平面而非椎体平面的颈椎病。只要严格掌握指征,其疗效确切,顽固性颈痛消失快,对脊柱稳定性干扰少,愈合快。有利于减少术后并发症的发生,是颈椎前路经典手术方式。
Objective To explore the surgical indication and summarize the experiences of anterior cervical discectomy and fusion （ACDF） for the treatment of cervical spondylosis. Methods Seventy-five cases of cervical spondylosis were treated with ACDF from January 2010 to October 2013, including 34 cases of cervical spondylotic radiculopathy and 41 cases of cervical spondylotic myelopathy. The pre/post-operative Japanese Orthopedic Association （JOA） score and imaging data were observed. Results Thirty-six patients were followed up for 6 to 25 months, with an average of 16 months. The mean JOA score before surgery was 10.67±2.66, and 3 months later, the score was 13.47±2.06. Six months later the score was 14.11±1.56, and after 12 months the score was 14.97±1.78. No spinal cord injury or esophagus, trachea injury occurred, and there was no superior laryngeal nerve and recurrent laryngeal nerve injury during the operation. Eight cases of postoperative dysphagia obviously decreased within 3-5 days, 6 cases decreased within 5-7 days, and 10 cases decreased within 3 weeks. And all 36 patients recovered within one month. There was no titanium mesh subsidence, displacement or titanium plate failure after operation. Conclusions ACDF is suitable for the decompression of spinal cord or nerve root which is compressed by the degenerated intervertebral disc, especially without rigid kyphosis, ossification of the posterior longitudinal ligament extending across multiple segments, and the compression located at the level of intervertebral disc. The appropriate approach can achieve a stable efficacy, less interference on the stability of the spine, and the incision heals fast. It is a kind of classic anterior cervical operation for it can reduce the complication effectively.
出处
《华西医学》
CAS
2015年第5期855-858,共4页
West China Medical Journal
基金
国家自然科学基金(30872602)~~
关键词
颈前路椎间盘切除椎间融合术
颈椎病
手术
体会
Anterior cervical discectomy and fusion
Cervical spondylosis
Surgery
Experience
