ACCF和ACDF治疗多节段脊髓型颈椎病的效果比较

Comparison on effect of ACCF and ACDF in the treatment of multilevel cervical spondylotic myelopathycer

目的比较颈前路椎间盘切除植骨融合术(ACDF)和颈椎前路椎体次全切除减压植骨融合术(ACCF)治疗多节段脊髓型颈椎病的临床效果。方法抽取郑州市骨科医院2017年2月至2020年2月收治的行手术治疗的94例多节段脊髓型颈椎病患者为研究对象,根据手术方式分为对照组和研究组。对照组采用ACCF治疗,研究组采用ACDF治疗,比较两组手术指标、颈椎病变疼痛、脊髓功能恢复、Cobb角、颈椎功能变化及术后并发症发生情况。结果研究组手术时间、术中出血量及住院时间均少于对照组(P均<0.05);术后,两组视觉模拟评分法(VAS)评分、颈椎功能障碍指数(NDI)降低,颈椎脊髓损伤日本骨科协会(JOA)评分、颈椎前凸Cobb角度及颈椎曲度值升高(P<0.05),但两组术前及术后3、6个月的VAS评分、JOA评分、Cobb角比较,差异未见统计学意义(P>0.05),但与对照组比较,研究组颈椎曲度值更高,NDI指数更低(P<0.05)。对照组并发症发生率(14.89%,7/47)与研究组(6.38%,3/47)比较差异未见统计学意义(P>0.05)。结论两种手术方式治疗多节段脊髓型颈椎病疗效均较好,ACDF可有效恢复颈椎生理曲度,手术创伤及并发症发生率较低。

Objective To compare the clinical effect of anterior cervical discectomy and bone graft fusion(ACDF)and anterior cervical corpectomy and fusionon(ACCF)in the treatment of multilevel cervical spondylotic myelopathy.Methods Ninety-four patients with multilevel cervical spondylotic myelopathy who received surgical treatment in Zhengzhou Orthopaedics Hospital from February 2017 to February 2020 were selected as the research objects,and they were divided into control group and research group according to surgery methods.ACCF was used in the control group,and ACDF was used in the research group.The operative indicators,cervical spondylosis pain,spinal cord function recovery,Cobb angle,cervical function changes and postoperative complications of the two groups were compared.Results The operative time,intraoperative blood loss and hospital stay in the study group were shorter than those in the control group(all P<0.05).After surgery,visual analogue scale(VAS)score and neck disability index(NDI)of the two groups decreased,while Japanese Orthopaedic Association(JOA)score,cervical lordosis Cobb angle and cervical curvature increased(P<0.05).However,there were no statistically significant differences in VAS score,JOA score and Cobb angle between the two groups before surgery,3 months and 6 months after surgery(P>0.05).However,compared with the control group,the study group had higher cervical curvature value and lower NDI index(P<0.05).There was no significant difference in the incidence of complications between the control group(14.89%,7/47)and the study group(6.38%,3/47),P>0.05.Conclusions ACDF and ACCF both have great therapeutic effects on multilevel cervical spondylotic myelopathy.ACDF can effectively restore the physiological curvature of cervical spine,and has lower surgical trauma and lower incidence of complications.