相邻两节段脊髓型颈椎病两种颈前路手术方式的比较

Comparison of the outcomes of two operating procedures for two-adjacent-level cervical spondylotic myelopathy

目的 对比分析前路颈椎体次全切除钛网植骨融合术（ACCF）和前路颈椎间盘切除融合器融合术（ACDF）两种手术方式治疗相邻两节段脊髓型颈椎病的疗效.方法 对行相邻两节段脊髓型颈椎病手术治疗的63例患者的临床资料和影像学资料进行回顾性分析,其中ACCF组34例,ACDF组29例.比较2组的手术时间、住院时间、术中出血量、脊髓神经功能JOA评分、颈椎生理曲度、椎体高度、融合节段稳定性及融合率.结果 与ACCF组比较,ACDF组手术时间明显缩短、术中出血量明显减少（P＜0.05或P＜0.01）,颈椎生理曲度及椎体高度均明显改善（P＜0.05或P＜0.01）.2组间住院时间、JOA评分、融合节段稳定性及末次随访融合率差异无统计学意义（P＞0.05）.结论 ACCF加钛网、ACDF加融合器均是治疗相邻两节段脊髓型颈椎病的有效术式,ACDF加融合器术在缩短手术时间、减少术中出血量、维持颈椎生理曲度及椎体高度方面有明显优势.

Objective To compare the outcomes of patients treated with either anterior cervical corpectomy with fusion （ACCF） or anterior cervical diseectomy with fusion （ACDF） for two - adjacent - level cervical spondylotic myelopathy. Methods The case histories of 63 patents underwent surgical treatment for two - adjacent - level cervical spondylotic myelopathy were retrospectively reviewed. These patients were either treated with ACCF （ ACCF group, n = 34） or ACDF （ ACDF group, n = 29）. The operation time, intra - operative bleeding amount, JOA score of spinal function, stability of the vertebral segment, vertebral height, and fusion rate between the 2 groups were compared. Results Compared with ACCF group, the operation time was significantly shorter and the intra - operative bleeding amount was significantly smaller in ACDF group （ P 〈 0.05 or P 〈 0.01 ） , cervical lordosis and vertebral height were significantly improved in ACDF group （ P 〈 0.05 or P 〈 0. 01 ）. Whereas the hospitalization time, JOA score of spinal function, the stability of the vertebral segment, and the last follow - up fusion rate were not significantly different between the 2 groups （ P 〉 O. 05 ）. Conclusion Our data suggest that the two procedures yield comparable results in terms of clinical outcomes for two - adjacent - level cervical spondylotic myelopathy. However, ACDF is considered to be superior to ACCF in shortening operation time, reducing intra - operative bleeding amount, and maintaining cervical lordosis and vertebral height.