人工颈椎椎间盘置换与颈前路减压融合术治疗脊髓型颈椎病的疗效分析

Comparison of artifical cervical disc replacement versus anterior discectomy and fusion for the treatment of cervical spondylotic myelopathy

目的比较人工颈椎椎间盘置换术与颈前路椎间盘切除减压植骨融合术(anterior cervical discectomy and fu-sion,ACDF)治疗脊髓型颈椎病的临床疗效。方法回顾性分析本院收治的人工颈椎椎间盘置换术及ACDF治疗的脊髓型颈椎病病例。测量所有患者颈椎活动度(range of motion,ROM),置换节段及相邻节段的ROM,并行日本骨科学会(Japanese Orthopaedic Association,JOA)评分及Odom分级。结果所有患者术后JOA评分和Odom功能评定均得到显著改善。置换组术后颈椎ROM、置换节段及其邻近间隙平均ROM无明显改变,差异无统计学意义(P>0.05)。ACDF组患者中,术后颈椎ROM显著减小,邻近间隙ROM明显增大,差异有统计学意义(P<0.05)。置换组术后邻近节段的ROM明显小于ACDF组,差异有统计学意义(P<0.01)。结论人工颈椎椎间盘置换术能保持颈椎ROM,避免邻近节段退变,早、中期疗效满意,远期效果尚有待临床进一步研究。

Objective To compare the clinical outcome of artifical cervical disc replacement versus anterior cervical dis- cectomy and fusion （ACDF） in the treatment of cervical spondylotlc myelopathy. Methods A total of 50 cases of cervical spondytotlc myelopathy treated by artifical cervical disc replacement （n = 20 ） or ACDF （n = 30） were involved. Among these cases , the range of motion （ROM） of the cervical vertebra, the implanted Ievel and the adjacent segment were measured. The Japanese Orthopaedic Association （JOA） score and Odom＇ s grade were record and analyzed. Results All of these patients were followed-up, and JOA score and Odom＇ s grade of all patients were significantly improved. The ROM of the cer- vical vertebrae, the implanted levels and the adjacent segments were preserved in artifical cervical disc replacement group （ P 〉 0. 05 ）. In the ACDF group, the ROM of the cervical vertebrae decreased, but the adjacent segments of the fusion seg- ment compensatory increased remarkably（ P 〈 0.05 ）. Bewteen 2 groups, the ROM of the implanted levels and the adjacent segments were not obvious different （P 〉 0.05） ;but the ROM of the adjacent segments in artifical cervical disc replacement group were less than the ACDF group, and the difference was statistically significant （P 〈 0. 05 ）. Conclusion The artifical cervical disc replacement can avoid the degeneration of adjacent segments and its early and midterm outcomes for the treatment of cervical spondylotic myelopathy are satisfactory, but the long-term effects still need studed.