颈椎前路融合与人工椎间盘置换术联合治疗多节段脊髓型颈椎病

Clinical study of a cervical anterior hybrid technique for multilevel cervical spondylotic myelopathy

目的:探讨颈椎前路减压后行融合与人工椎间盘置换联合手术治疗多节段脊髓型颈椎病的临床疗效。方法:2008年10月～2009年6月共收治多节段脊髓型颈椎病患者52例,其中24例行颈椎前路减压融合与人工椎间盘置换联合手术(A组),28例采用颈椎前路椎体次全切联合椎间盘切除植骨内固定术(B组)。两组患者分别在术前、术后3d、3个月、12个月、24个月时应用JOA评分评价临床疗效;统计两组的手术时间及出血量;摄颈椎前屈后伸位X线片观察人工椎间盘活动度及颈椎整体活动度;行MRI或CT扫描检查假体位置及异位骨化情况。结果:两组患者术后临床症状缓解,脊髓功能改善,均无严重并发症。JOA评分结果示各组术后各时间点JOA评分较术前明显提高(P<0.01),两组术后各时间点间比较无显著性差异(P>0.05)。与B组比较,A组手术时间短,术中出血量少(P<0.05),置换节段活动度维持良好,颈椎整体活动度恢复较快且较好(P<0.05)。末次随访时,A组人工椎间盘置换节段未发现异位骨化,未见邻近节段退变;B组中2例出现邻近节段退变。结论:与单纯前路融合手术相比,前路融合与人工椎间盘置换联合手术治疗多节段脊髓型颈椎病既能缩短手术时间、减少出血量,又能在达到良好前路减压目的的同时维持手术节段活动度及颈椎整体曲度,减少手术邻近节段代偿活动度的增加,从而预防相邻节段退变的发生。

Objective：To explore the early clinical effects of cervical anterior hybrid technique using anterior corpectomy and fusion （ACF） combined with cervical artificial disc replacement （C-ADR） for muhilevel spondylotic myelopathy.Method：Hybrid technique was applied in 24 cases of multilevel cervical spondyiotic myelopathy （group A）,and 28 patients were treated by the traditional anterior noncontiguous decompression and fusion（group B） between Oct 2008 and Jun 2009. Clinical results were evaluated by JOA score preoperatively and postoperatively at 3d,3 months,12 months,and 24 months.The operative time and blood loss were recorded.The range of movement（ROM） in replaced segment and C2-7 of all cases were evaluated by radiograph （X-rays of bending,extending）.CT or MRI scan was applied postoperatively to find out the pressure of the spine and heterotopic ossification in the replaced segment.Result：There was no serious complication.Improvement in all cases occurred obviously,and JOA score increased（P〈0.01） and stabilized postoperatively in all cases.There was no difference in JOA score between two groups （P〉0.05）.The mean C2-7 ROM of both groups did not recover to the preoperative value,but group A showed faster and better C2-7 ROM recovery. Replaced segment achieved stability and restored partial of ROM.There was no prosthesis subsidence or excursion.No hetertopic ossification was found in the replaced level,and the movement had no significant difference（P〉0.05） between preoperative and postoperative at two years post-operation.But the deteriorated adjacent level of 2 cases were found in group B.Conclusion：In term of surgical time,blood loss and restoring stability and partial motion of the C2-7 ROM,the anterior hybrid technique is superior compared with the traditional anterior noncontiguous decompression and fusion.At the same time,less compensatory motion occurs at the adjacent segments,and less ASD will result.