两种手术方法治疗双节段脊髓型颈椎病的疗效比较研究

Case-control study of two methods in treating two-level cervical spondylitic myelopathy

目的比较经椎间隙减压植骨融合术（ACDF，A组）和保留椎体后壁的椎体次全切除减压植骨融合术（ACCF，B组）治疗双节段脊髓型颈椎病的疗效。方法回顾性分析自2006年3月-2010年2月行手术治疗并获得随访的双节段脊髓型颈椎病32例，采用双节段椎间隙减压、植骨融合术15例，保留椎体后壁的椎体次全切除减压组17例。结果A组手术时间及术中出血量均少于B组（P〈0．05）。两组术后1周、3个月及12个月JOA评分与术前比较，差异有统计学意义（P〈0．05），两组各时间段比较差异无统计学意义（P〉0．05）。两组术后12个月复查均达到骨性融合。两组间术后1周融合节段曲度、全颈椎曲度及融合节段高度的差异无统计学意义（P〉0．05）。术后3个月及12个月，两组融合节段曲度和全颈椎曲度的差异无统计学意义（P〉0．05），而融合节段高度A组明显高于B组（P〈0．05）。结论2种方法均可获得满意的效果．ACCF视野清楚，操作更方便．但其创伤大、出血多，而且在维持融合椎体高度方面比ACDF差，存在钛网下沉现象。

Objective To compare the clinical effects between anterior cervical discectomy with fusion （ACDF） and anterior cervical compectomy with fusion （ACCF） in the treatment of two-level cervical spondylitic myelopathy. Methods From March 2006 to February 2010, the clinical data of 32 patients with two-level cervical spondylitic myelopathy who underwent ACDF （group A, 15 cases） or ACCF （group B, 17 cases） were retrospectively analyzed. Results Volume of loss blood during operation, operative time in group A were less than that of group B （P 〈0.05）. Compared with that before operation, postoperative 3OA score at 1 week, 3 months and 12 months were improved in two groups （P 〈0.05）, but there was no significant difference in all periods between two groups （P 〉0.05）. All the patients obtained bone fusion at 12-month after operation between two groups. At the 1 week after operation, there were no significant difference in fusional segment curvature, cervical curvature and fusional segment height between two groups （P 〉0.05）; and at the 3, 12 months after operation, there were no significant difference in fusional segment curvature and cervical curvature between two groups, but fusional segment height,in group A was higher than that of group B （P 〈0.05）. Conclusion Two methods both can obtain satisfactory effects in treating two-level cervical spondylitic myelopathy. ACCF has advantages of clear view, simple operation, but the method can 1 result in severe trauma and more loss blood. Moreover, the method in aspect of keeping fusion segment height is poorer than that of ACDF. Mesh subsidence may occur with this method.