摘要
[目的]比较分析治疗多节段颈椎病前路不同减压植骨融合术式的临床疗效,探讨如何选择多节段颈椎病的前路减压植骨融合术式。[方法]回顾性分析本院2004年1月~2013年1月采用颈前路不同减压术式治疗的85例多节段颈椎病患者资料。根据手术方式分三组：长节段椎体次全切除减压A组25例,多平面椎间隙减压B组30例,椎体次全切除结合椎间隙减压C组30例,比较分析三组手术时间、术中出血量、术后的JOA评分改善优良率、颈椎曲度Cobb角、融合率及并发症率等。[结果]所有患者均获得至少2年随访,平均手术时间[分别为（158.80±28.55）min,（164.67±24.24）min,（142.5±26.51）min]C组与A、B组之间比较差异有统计学意义（P〈0.05）;平均出血量[分别为（264.86±84.80）ml,（203.33±83.34）ml,（211.67±76.21）ml]A组与B、C组之间比较差异有统计学意义（P〈0.05）。术后JOA评分改善优良率和并发症率三组之间比较差异均无统计学意义（P〉0.05）。融合率（3组分别为60%,83.33%,90%）,A组与C组之间比较差异有统计学意义。术后1年颈椎Cobb角增加值[分别为（5.48±2.63）°,（9.43±3.85）°,（8.76±2.71）°]A组与B、C组之间比较差异有统计学意义。[结论]采用颈椎前路三种不同减压植骨融合术式治疗多节段颈椎病在改善神经功能上没有明显区别,但是混合式减压植骨融合术后融合率最高,多椎间隙减压和混合减压植骨融合术后颈椎曲度恢复优于长节段椎体次全切除减压术。
[ Objective] To compare the clinical outcomes, radiological parameters of 3 anterior approach decompression and fusion techniques of multilevel cervical spondylotic myelopathy （CSM） . [ Methods ] A total of 85 consecutive patients with multi -level CSM undergoing the anterior decompression and fusion procedures from January 2004 to January 2013 were ret- rospectively investigated. According to various decompression techniques, the patients were divided into three groups： anterior cervical corpectomy and fusion （ACCF） （group A, n = 25 ）, anterior cervical discectomy and fusion （ACDF） （group B, n = 30） and hybrid decompressio and fixation （HDF） （group C, n = 30） . The JOA scores and improvements of cervical lordosis in each group were assessed. In addition, the fusion rate, postoperative complications regarding each group were also evaluated and compared between groups. SAS 8.0 software was used for statistical analysis. [ Results] All patients were followed up for more than 2 years. No statistical differences in improvements of JOA scores, cervical Cobb angle, and incidences of postoperative complications were found among 3 groups （ P 〉 0. 05 ） . The patients in group A had more bleeding, and lower fusion rate com- pared with those in group B and C （ P 〈 0. 05 ） . The operation in group C had less duration time compared with those of the group A and B （P 〈 0. 05 ） . The improvements of the cervical Cobb angle in the group B were significantly more than that of group A （P 〈 0. 05 ） . [ Conclusion] Three surgeries had similar clinical outcomes, but the fusion rate of HDF technique is superior to multi - segment ACI）F and ACCF, and the improvement of cervical Cobb angle of ACCF technique is inferior to muhi -segment ACDF and HDF.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2015年第23期2118-2122,共5页
Orthopedic Journal of China
关键词
多节段颈椎病
前路
减压
融合
multi - level cervical spondylotic myelopathy, anterior, decompression, fusion
