摘要
目的 比较分析前后路联合不使用钢板（ CAPF）与单纯前路融合器加用钢板（ AFA）两种术式对多节段颈椎病的疗效. 方法 回顾性分析2011年3月~2014年3月手术治疗的60名患者. A组患者接受前路融合器加用钢板融合术（AFA）,B组患者接受前路融合器联合后路钉棒系统融合术（ CAPF）. 角度矫正程度及维持情况、融合率以及邻近节段的退变情况通过影像学检查来评估,临床效果通过颈椎VAS,NDI评分、手术时间、出血量及并发症发生率评估. 结果 平均矫正角度在两组间无显著差异,但在末次随访中A组病例在颈椎曲度矫正丢失度方面较B组病例高（P〈0.05）,与B组患者相比,A组患者有更高的假关节发生率、融合器下沉发生率、植入物相关并发症以及吞咽困难发生率. 上肢疼痛的平均VAS分值以及平均NDI分值,B组要优于A组（P〈0.05）,但是颈后痛的平均VAS分值,A组优于B组（P〈0.05）. B组的出血量及手术时间比A组长（P〈0.05）. 结论 尽管前后路联合融合术比单纯前路融合术手术时间长、出血量多,前后联合融合术提供了更好的维持颈椎曲度、高融合率、低融合器下沉和低邻近节段退变率及更好的VAS和NDI评分,前后路联合手术是治疗多节段颈椎病安全有效的手术方式.
Objective To compare clinical outcomes of combined anteroposterior fusion （CAPF） with that of anterior fusion alone （ AFA） for the treatment of multi-level cervical degenerative desease .Methods From March 2011 to March 2014,a total 60 cases of multi-level degenerative cervical disease were retrospectively reviewed .All the patients were divided into CAPF group and AFA group ,depending on different surgical methods.Of 60 patients,35 underwent anterior fusion with a cage and plate construct （group A）,and 25 underwent combined anterior fusion with a cage and posterior fusion with a rod/screw construct（group B）.The degree and maintenance of the correction angle ,fu-sion rates,and adjacent level degeneration were assessed by radiographs .Clinical outcomes were evaluated by a visual analog scale （ VAS） and Neck Disability Index（NDI） scores,operative time,blood loss,and rates of complications.Results The mean correction angle did not differ significantly between groups ,but the loss of correction at final follow-up was greater in group A than group B .Compared with group B ,group A had a higher incidence of pseudarthrosis ,cage subsidence ,hardware-related complications ,and dysphagia .The mean VAS score for arm pain and the mean NDI score were better for group B than group A ,but the mean VAS score for posterior neck pain was better for group A than group B.Group B had greater blood loss and a longer operative time than group A .Conclusions Although combined anterior/posterior fusion is associated with a longer operative time and greater blood loss than anterior fusion alone ,the combined approach provides better maintenance of sagittal alignment ,a higher rate of fusion ,a lower incidence of cage subsidence and adjacent level disease ,and better VAS and NDI scores ,CAPF is a safe and effective surgical option in the treatment of multi-level cervical degenerative desease .
出处
《潍坊医学院学报》
2015年第5期338-340,F0004,共4页
Acta Academiae Medicinae Weifang
