颈前路减压cage融合术与自体髂骨块植骨钛板内固定术治疗脊髓型颈椎病的中期疗效

Anterior cervical discectomy and interbody fusion with PEEK cage or autogenous iliac crest graft for the cervical spondylotic myelopathy:a mid-term follow up results

目的:观察颈椎前路减压cage植骨融合术与颈椎前路减压自体髂骨块植骨融合钛板内固定术治疗脊髓型颈椎病的中期临床疗效。方法:2001年1月～2006年4月128例脊髓型颈椎病患者按照手术方式分为A、B两组,A组61例患者采用前路减压单纯PEEK cage植骨融合术治疗,其中病变节段与手术节段均为单节段22例,双节段39例;B组67例采用颈椎前路减压自体髂骨块植骨融合钛板内固定术,其中单节段27例,双节段40例。观察手术前后JOA评分、椎间高度和颈椎曲度情况。结果:A组手术时间为58.1±1.4min,术中出血量为42.4±2.0ml,B组分别为72.0±5.3min、82.7±3.9ml,两组比较差异有统计学意义(P<0.05)。A组23例(39.3%)出现一过性咽部不适,1例硬脊膜破裂,2例cage塌陷、移位;B组49例(73.1%)出现一过性咽部不适,1例硬脊膜破裂,5例髂骨供区痛,2例钉板松动。每组患者术后JOA评分、椎间高度和颈椎曲度均较术前明显改善(P<0.05),A、B组术后JOA评分改善率分别为(82.30±6.61)%和(83.80±4.42)%,组间比较差异无统计学意义(P>0.05)。随访24～60个月,平均36个月,末次随访时A、B组椎间融合率分别为95.2%和96.3%,两组比较差异无统计学意义(P>0.05);末次随访时每组JOA评分、椎间高度和颈椎曲度与术后比较差异无统计学意义(P>0.05)。术前、术后和末次随访时JOA评分、椎间高度和颈椎曲度两组比较差异无统计学意义(P>0.05)。结论:颈椎前路减压cage植骨融合术与颈椎前路减压自体髂骨块植骨融合钛板内固定术治疗脊髓型颈椎病的中期疗效均较好,但前者手术方法简单、近期并发症少。

Objective：To evaluate the mid-term clinical results of anterior cervical discectomy and interbody fusion with PEEK cage or autogenous iliac crest graft for cervical spondylotic myelopathy.Method：From January 2001 to April 2006,128 cases with cervical spondylotic myelopathy were divided into group A and B respectively.61 cases in group A underwent anterior cervical decompression and fusion（ACDF） with PEEK cage（22 single-level and 39 double-level）,while 67 cases in group B underwent anterior decompression and fusion procedures with autogenous iliac crest graft（27 single-level and 40 double-level）.The disc height and cervical lordotic alignment were assessed by radiographs,and JOA scores during the follow-up were also reviewed retrospectively.Result：The surgical time and blood loss in group A（58.1±1.4min and 42.4±2.0ml respectively） were less than those in group B（72.0±5.3min and 82.7±3.9ml respectively）（P0.05）.In group A,23 cases（39.3%） presented with swallow pain,1 case suffered cerebrospinal fluid leakage,and cage subsidence occured in 2 cases.In group B,49 cases（73.1%） presented with swallow pain,5 cases suffered pain in donate site,1 case had cerebrospinal fluid leakage,and instrument displacement occured in 2 cases.The postoperative JOA scores,cervical lordotic alignment and disc height improved obviously in both groups（P0.05）.The improve rate of JOA scores were（82.30±6.61）% for group A and（83.80±4.42）% for group B,with no significant difference（P0.05）.The mean follow-up period for all cases was 36 months（range,24-60 months）.At final follow up,the fusion rate was 95.2% in group A and 96.3% in group B（P0.05）.The cervical lordotic alignment and disc height showed no statistical significances between two groups（P0.05）.Conclusion：Both surgical protocols have reliable mid-term outcome,however,ACDF with cage placement presented with less early-stage complications.