三种前路手术方法治疗颈椎不稳的临床比较研究

Clinical Comparison of Three Anterior Surgeries for Cervical Spinal Instability

目的分析比较三种颈前路手术对颈椎不稳的治疗效果。方法选择84例患者手术前后情况进行回顾。第Ⅰ组38例为椎间盘切除减压自体髂骨植骨融合并钛板内固定术患者,第Ⅱ组17例为椎间异体骨笼植入融合术患者,第Ⅲ组29例为钛板内固定+椎间异体骨笼植入融合术患者。比较三组改善率、植入物融合率、椎间隙高度及颈椎生理曲度的恢复程度,并结合手术时间、并发症及治疗总费用,评估三种治疗方案的优缺点。结果三组患者术后JOA评分均得到改善,有效率达90%,术后椎间隙高度恢复,颈椎生理曲度维持良好。无钢板、螺钉折断、滑脱等并发症,三组改善率、植入物的融合率、椎间隙高度及颈椎生理曲度的恢复程度无统计学差异(P>0.05),加用内固定手术时间及费用随之增加,应用自体髂骨移植费用相对便宜。结论充分的前路减压及牢固的植骨融合是手术关键,合理的选择病例,根据不同的病例特点科学地制订手术方法可取得满意的疗效。

Objective To analyze the clinical outcomes of anterior decompression and different spinal fusion methods with or without internal fixation for the treatment of cervical spinal instability. Methods In the retrospective study, 84 patients with cervical spianal instability were divided into three groups. The patients in three groups were treated by anterior cervical discectomy and interbody fusion with autogenous iliac bone grafting plus anterior cervical plate screw fixation in 38, allograft cage in 17, allograft cage with anterior cervical plate screw fixation in 29, improvement rate of JOA scores, the bony fusion, height of intervertibral space, and the physiological curve of cervical spine were evaluated during follow-up; Operationtion time and complications and total treatment cost were also analyzed. Results All patients had JOA improvement after surgery. The improvement rate was 90 percent, the restoration of the intervertebral spaces were maintained after operation. The physiological curve of cervical spine was good. No complications occurred, such as breaking of the plate and screw. No statistical significance was noted among these three groups in JOA scores, the bony fusion rate , height of intervertibral space ,and the physiological curve of cervical spine （P 0.05）, operation time and total treatment cost increased when internal fixation was used. The cost of patients using Autogenous iliac bone grafting was lower. Conclusion Effective anterior decompression and solid fusion are vital for cervical spinal instability; Different surgery methods should be seleceted according to different clinical status of patients.