保留椎体后壁的椎体次全切除术治疗多节段颈椎病的前瞻性研究

Anterior cervical corpectomy and fusion with preserved posterior vertebral wall for multi-level cervical spondyiosis: a prospective random study of 84 cases

目的报告一种改良椎体次全切除术术式,并与传统的椎体次全切除术比较。方法2003年3月—2005年1月,84例多节段颈椎病患者随机行保留椎体后壁的椎体次全切除术(PWCF)和经典的椎体次全切除术(ACF)各42例,比较两组手术时间、出血量、住院时间、住院费用、并发症、术后JOA评分、植骨融合率、节段高度、颈椎曲度等多项指标。结果两种术式术后短期JOA评分无明显差异。PWCF组较ACF组手术时间短、出血量少。术后3个月两组植骨融合率均为100％。颈椎曲度和节段高度两组无差异。结论PWCF是一种切实有效的颈椎前路减压植骨融合术式,具有简便、风险小和植骨融合率高的优点。

Objective To compare the results of anterior cervical corpectomy and fusion with preserved posterior vertebral wall（PWCF） with the classical anterior cervical corpectomy with fusion （ACF）. Methods Eighty-four patients with multi-level cervical spondylosis were randomized to ACF （ n = 42 ） or PWCF （ n = 42 ） . Postoperative JOA score were evaluated by an independent observer. Fusion rate, segmental lordosis, and disc height were assessed by radiographs at postoperative 3 months, 6 months, and 12 months. Fusion evidence was observed by CT scan. Results JOA score improvement was similar for both treatments. The operation time was shorter in the PWCF group than in the ACF group. The intraoperative blood loss was less in the PWCF group than in the ACF group. Fusion rate was 100% for both groups 3 months after operation. The segmental lordosis and the disc height increased were similar in both groups. Conclusions Except for reduced risk, time and blood loss during the operation, PWCF is the same as for ACF procedure. Reservation of posterior vertebral wall results in more reliable fusion. But replication of the results by other team and intensive assessment still need to be carried out.