两种椎体次全切手术方式治疗相邻节段颈椎病疗效比较

Comparative Study of Two Kinds of Corpectomy for the Treatment of Adjacent Two-level Cervical Spondylosis

目的:比较保留椎体后壁与否的两种椎体次全切钛笼钛板内固定手术方式治疗相邻节段颈椎病的临床疗效。方法:行颈前路手术治疗的相邻节段颈椎病患者40例,依据手术方式分为不保留椎体后壁的椎体次全切钛笼钛板内固定组(A组)21例,保留椎体后壁的椎体次全切钛笼钛板内固定组(B组)19例。比较两组手术时间、术中出血量、JOA评分、临床疗效、Cobb's角及椎间高度变化,并观察植骨融合情况。结果:所有患者均随访18个月以上,平均22个月。B组手术时间、出血量均大于A组,椎间高度及Cobb's角的丢失,A组大于B组,差异均有统计学意义(P<0.05)。两组临床疗效、JOA评分、并发症发生率差异均无统计学意义(P>0.05)。两组术后椎间高度及Cobb's角较术前均有提高(P<0.05),但组间差异无统计学意义(P>0.05)。末次随访时植骨融合率均为100%。结论:两种手术方式治疗相邻节段颈椎病均可获得可靠的临床疗效,保留椎体后壁的手术方式可减少术后椎间高度及Cobb's角的丢失,但操作相对复杂,手术时间长,术中出血量相对较多,术中如发现椎体后缘骨赘较多,难以操作,应及时更换手术方式。

Objective：To compare the outcome of corpectomy with titanium cage and plate fixation for two-level cervical spondylosis（CS）that keeping the posterior wall of the vertebral or not.Methods： A retrospective analysis on the anterior cervical surgery in 40 cases of two-level CS was conducted and the patients were divided into 2 groups according to different surgical mode.In Group A,21 cases did not keep the posterior wall of the vertebral and in Group B,19 cases kept the posterior wall of the vertebral.The operation time,blood loss,JOA scores,clinical outcomes,the height and Cobb’s angle of the fused segments,and bone fusion were compared between the 2 groups.Results： All the patients were followed up for at least 18 months with a mean time of 22 months.A longer operation time and more intraoperative blood loss were seen in Group B as compared with Group A（P〈0.05）,while a greater loss of the height and the Cobb’s angle of the fused segments were noted in Group A than Group B（P〈0.05）.The clinical outcomes,JOA scores,and incidence of complication were not different in Group A and Group B（P〉0.05）.The height and the Cobb’s angle of the fused segments were improved in both groups after surgeries without difference between the 2 groups（P〉0.05）.The spinal fusion rate of the two groups were both 100% at the final follow-up.Conclusion： Both methods can obtain positive effect on adjacent two-level cervical spondylosis.Keeping the posterior wall of the vertebral can reduce the loss of the height and the Cobb’s angle of the fused segments,but the surgical procedures are relatively complex with longer time and more blood loss.When too much osteophyma is found during the surgery,it should promptly change decompression to corpectomy with no keeping the posterior wall of the vertebral.