分节段减压与椎体次全切治疗多节段颈椎病的疗效比较

Comparison of Two Anterior Cervical Spine Decompression Combined with Autograft and Fusion for Multilevel Cervical Spondylotic Myelopathy

目的 比较分节段减压融合术与传统椎体次全切除融合术在治疗多节段脊髓型颈椎病的中远期临床疗效,并评估其相关影响因素.方法 回顾性总结2006年6月至2011年6月行分节段减压融合术（A组）与前路椎体次全切除减压融合术（B组）联合髂骨取骨植骨治疗多节段颈椎病52 例.比较两组手术时间、术中出血量、住院天数;术后随访并通过影像学测量融合节段前凸角度、全颈椎生理曲度和颈椎矢状面的活动度（range of motion,ROM）,同时评估植骨融合程度、融合节段高度的变化以及相邻节段退变情况;采用日本矫形外科学会（Japanese orthopaedic association,JOA）评分系统评估其神经功能恢复情况.结果术中B组的出血量明显大于A组,但手术时间少于A组,差异有统计学意义（P＜0.05）.52 例患者均获得有效随访,平均随访时间为3.2年（1.2～5年）.术后6个月内JOA评分及改善率两组间无明显差异;12个月后B组明显降低.两组术后融合节段高度较术前明显增高（P＜0.05）,其中B组平均增加值最明显,术后12个月B组高度丢失明显.术后两组ROM都明显下降,而融合节段Cobb角及全颈椎曲度与术前比较增加明显（P＜0.05）.术后两组脊髓减压程度相仿.结论 分节段减压融合术与传统椎体次全切除融合术两种手术方式在治疗多节段颈椎病的早期均可获得满意的临床效果,但选择性椎体次全切除分节段减压植骨融合合并颈椎前路长节段钛板固定的手术方式中远期效果更可靠.

Objective To compare the clinical results and assess correlated influential factors of three anterior cervical spine decompression combined with autograft and fusion for multilevel cervical spondylotic myelopathy. Methods From 2006 to 2011, fifty-two patients of multilevel cervical spondylotic myelopathy treated with anterior cervical hybrid decompression and fusion（ ACHDF, combination of ACDF and ACCF, group A） and anterior cervical corpectomy with fusion （ACCF, group B ） were enrolled retrospectively in this study. The clinical outcomes including blood loss, operation time, hospital stay, incremental curvature of segments, cervical spine curvature of segments, range of motion, fusion rate, incremental height of segments, and Japanese Orthopedic Association （JOA） scores were compared. Results Compared with group A, group B had more blood loss and shorter operation time, and the differences were statistically significant（ P 〈 O. 05 ）. All patients were followed up for 1.2 5 years, with the median of 3.2 years. After operation, the JOA improvement of group A had no significant differences with group B. 12 months after operation, the JOA improvement of group B decreased obviously. The postoperative incremental height of segments,incremental curvature of segments and cervical spine curvature of segments increased obviously in every group（ P 〈 O. 05 ）. The decompression of spinal cord in group A were the same with B. Conclusion Both of the surgical managements for multilevel cervical spondylosis by ACCF and ACHDF could acquire satisfied clinical satisfied clinical outcome. However, the middle and long term outcome of ACHDF is better than ACCF.