颈前路减压+MC+颈椎融合器植骨融合与椎体次全切除融合钛板置入内固定治疗单节段脊髓型颈椎病的比较

Anterior cervical decompression plus MC+ cervical fusion cage versus anterior corpectomy plus titanium plate internal fixation for treatment of single-level cervical spondylotic myelopathy

背景:颈前路减压植骨融合内固定目前已成为脊髓型颈椎病前路手术的"金标准";但对于治疗单节段脊髓型颈椎病是否应用内固定,尚存在争议。近年来,颈椎融合器植骨融合在其治疗中已扮演了十分重要的角色。目的:比较颈前路经椎间隙减压+MC+颈椎融合器植骨融合与椎体次全切除减压+钛网植骨融合钛板置入内固定治疗单节段脊髓型颈椎病的临床疗效。方法:42例单节段脊髓型颈椎病患者随机分为2组,实验组应用颈前路经椎间隙减压+MC+颈椎融合器植骨融合治疗,对照组应用颈前路椎体次全切除减压+钛网植骨融合钛板置入内固定治疗。结果与结论:每组患者治疗后JOA评分及颈椎曲度均较治疗前明显改善(P<0.05)。所有病例随访12～29个月,治疗后6个月及末次随访时每组JOA评分、颈椎曲度与治疗后相比差异无显著性意义(P>0.05);两组患者治疗前、治疗后、治疗后6个月和末次随访时JOA评分及颈椎曲度相比差异无显著性意义(P>0.05);末次随访时两组植骨融合率均为100%,未见内置物松动、下沉。实验组治疗后发生声音嘶哑1例,对照组治疗后发生声音嘶哑1例、吞咽困难3例及食管损伤2例。提示两种方法治疗单节段脊髓型颈椎病的临床疗效可靠,均能获得治疗后颈椎的稳定性;但前者方法简单,近期并发症少。

BACKGROUND：Anterior cervical decompression and fusion has become the golden standard of anterior cervical surgery for the treatment of cervical spondylotic myelopathy （CSM）.But for single level CSM,whether fixation is needed remains controversial.Cervical cage fusion combined with bone grafting plays a very important role in treating single-level CSM in recent years.OBJECTIVE：To compare the clinical curative effects of anterior decompression and implantation of MC＋ cervical intervertebral fusion cage combined with bone grafting with anterior cervical vertebrectomy and fixation of titanium plate on the treatment of single-level CSM.METHODS：Totally 42 single-level CSM patients were randomly divided into two groups.Patients treated by anterior decompression and implantation of MC＋ cervical intervertebral fusion cage combined with bone grafting were taken as experimental group.Patients in control group were treated by anterior corpectomy and titanium plate internal fixation combined with bone grafting.RESULTS AND CONCLUSION：The postoperative Japanese Orthopedic Association （JOA） scores and cervical curvature improved obviously in both groups （P〈0.05）.All cases were followed up for 12-29 months.At six months after surgery and the final follow-up,the JOA scores and the cervical curvature showed no significant differences from those postoperatively （P〉0.05）.The JOA scores and cervical curvature showed no statistical differences between the two groups prior to and after surgery as well as at each follow-up （P〉0.05）.At the final follow-up,the fusion rate was 100%,neither of the groups had implantation loosening or protrusion.After operation,one case of hoarseness occurred in the experimental group,and in the control group there were one case of hoarseness,three cases of dysphagia,and two cases of esophageal injury.The results indicated that both of the two surgical methods have reliable clinical outcomes for single-level CSM;however,the former one is simpler and has fewer early complications.