两种颈椎前路减压融合术治疗脊髓型颈椎病的临床疗效分析

Clinical results of anterior cervical discectomy or corpectomy in 2-level cervical spondylotic myelopathy

[目的]回顾性分析比较椎间盘切除减压融合术（ACDF）和椎体次全切除减压融合术（ACCF）在治疗相邻两个节段脊髓型颈椎病的临床疗效及影像学数据。[方法]2005年4月~2007年8月,采用ACDF和ACCF治疗相邻两个节段脊髓型颈椎病156例。临床疗效采用日本骨科学会评分系统（JOA评分）对术前、末次随访的临床疗效进行评价。比较两组患者临床疗效及手术时间、住院天数、术中失血量、颈椎活动度、颈椎曲度及节段性高度。[结果]两组的临床改善优良率无显著性差异（P〉0.05）,ACDF组与ACCF组术中平均出血量及手术时间有显著性差异（P〈0.01）,ACCF较ACDF增加,而ACCF组术后的节段性高度及颈椎前凸角较ACDF组明显降低（P〈0.01）。[结论]ACDF与ACCF均能达到良好的手术疗效,然而ACDF在减少术中出血量、手术时间,改善和维持术后颈椎前凸角度及节段性高度较ACCF作用明显,但ACDF要求技术较高,有较长的学习曲线。

[Objective]To investigate clinical and radiologic outcomes after surgical treatment for 2-level cervical spondylotic myelopathy with anterior cervical discectomy and fusion（ACDF） and anterior cervical corpectomy and fusion（ACCF）. [Methods]The sample included 156 patients who underwent ACDF and ACCF.Clinical symptoms were assessed based on the Japanese Orthopedic Association Scores（JOA）.All medical and surgical records were examined and analyzed,including pain-free interval,intraoperative blood loss,length of surgery,postsurgery hospital stay and radiologic parameters（total cervical range of motion,segmental cervical range of motion,cervical lordosis,segmental height,fusion rate）.[Results]The operation time（P0.01） and bleeding amount（P0.01） were significantly greater in the ACCF group,whereas segmental height（P0.01） and postoperative cervical lordosis（P0.01） were significantly lower in the ACCF group.However,other parameters were not significantly different between the 2 groups（P0.05）.[Conclusion]ACDF or ACCF had been found to have similar clinical results in 2-level cervical spondylotic myelopathy without ossification.However,ACDF has been found to be superior to ACCF in terms of operation time,bleeding amount,and radiologic outcomes,although ACDF is a more technical job.