两种手术方法治疗单节段颈椎病的疗效观察

Observation of the curative effect due to two different surgical treatment methods of single-level cervical spondylosis

目的探讨单节段颈椎前路减压后有无必要在椎间融合器(Cage)植入基础上加用钢板固定。方法自2006-08-2010-08对55例实行单节段颈椎前路减压手术的颈椎病患者进行随访。根据手术方式分2组:A组21例行颈椎前路减压单纯Cage植骨,B组34例行颈椎前路减压Cage植骨加钢板内固定。根据手术情况、症状改善情况及影像学资料对两组患者作分析比较。结果手术时间和出血量两组差异无统计学意义(P>0.05),放射性暴露时间两组差异有统计学意义(P<0.05)。术后JOA评分改善率两组差异无统计学意义(P>0.05),术后融合率两组差异有统计学意义(P<0.05)。两组颈椎生理曲度术后明显改善(P<0.01);术后随访1年时颈椎的生理前凸丢失程度两组间有显著性差异(P<0.01)。两组椎间高度术后改善明显(P<0.01);术后随访1年椎间高度丢失程度两组有显著性差异(P<0.01)。结论单节段颈椎前路减压单纯Cage植骨融合和加用钢板固定两种手术方式都是安全、可靠的,加用钢板有助于保持椎间高度及颈椎生理曲度、减少椎间隙塌陷和促进融合。

Objective To compare the clinical and radiography results of single-level anterior cervical discectomy and fusion with Cage with or without anterior cervical plate fixation.Methods 65 patients suffered from single-level cervical spondylosis which were treated surgically with anterior cervical discectomy and fusion form August 2006 to August 2010 were reviewed.According to the operative method divided into 2 groups： group A 21 were treated surgically with anterior cervical discectomy and fusion with Cage;group B 34 cases were treated surgically with anterior cervical discectomy and fusion with Cage and anterior cervical plate fixation.To compare the clinical and radiographie results of Two groups.Results The operation time and amount of blood loss between two groups was not statistically significant（P〈0.05）,the radioactive exposure time between two groups was statistically significant（P〈0.05）.The improvement rate JOA score between two groups was not statistically significant（P〈0.05）,The cervical fusion rate between two groups was statistically significant（P〈0.05）.The cervical physiology lordosis after operation between two groups improve significantly（P〈0.01）;Follow-up of one year the lost degree of cervical physiology lordosis between two groups was statistically significant difference（P〈0.01）.The height of intervertebral gap after operation between two groups improve significantly（P〈0.01）;Follow-up of one year the Lost degree of height of intervertebral gap between two groups was statistically significant difference（P〈0.01）.Conclusion Single-level anterior cervical discectomy and fusion with Cage with or without anterior cervical plate fixation are safe and reliable,using anterior cervical plate fixation helps to keep the height of intervertebral space and cervical physiology lordosis,preventing the collapse of intervertebral gap,and promoting early fusion.