两种前路术式治疗多节段脊髓型颈椎病的近期随访研究

A follow- up study of two anterior surgical interventions for multi- segmental cervical spondylotic myelopathy

[目的]通过分析比较对治疗多节段脊髓型颈椎病的两种前路术式进行探讨研究。[方法]回顾性分析2008年1月一2011年8月手术治疗的65例三节段脊髓型颈椎病患者的临床资料，根据手术方式不同分为2组：前路椎间盘切除减压融合术组（anterior cervical discectomy with fusion，ACDF）（A组）、前路椎体切除减压融合术组（anterior cervical corpectomy with fusion，ACCF）（B组），其中A组男性20例，女性7例；平均年龄（50．43±6．50）岁；B组男性25例，女性13例；平均年龄（52．31±7．32）岁；评估2种术式围手术期并发症的发生率、手术时间、手术出血量及神经功能改善率、生理弧度改善情况。[结果]随访时间13—34个月，平均20个月。共有7例在手术后出现多种并发症，包括植骨未融合2例（B组）（5．26％），B组植骨不愈合发生率显著高于A组（P〈0．05）；声音嘶哑1例，其中B组l例（2．63％）；吞咽困难2例，其中A组1例（3．70％），B组1例（2．63％）；脑脊液漏1例（A组）；切口感染1例（B组）。A组患者并发症发生率为7．40％，B组为13．15％，B组患者术后并发症的发生率显著高于A组（P〈0．05）。两组手术时间分别为（107．9±32．4）min、（129±23）min，两组间比较差异有统计学意义（P〈0．05）；神经功能平均改善率分别为55．3％和56．9％，两组间比较差异无统计学意义（P〉0．05）；A组手术前颈椎融合节段Cobb角为（7．78±1．15）°，末次随访时Cobb角为（15．82±3．27）°；B组手术前颈椎融合节段Cobb角为（8．36±2．57）°，末次随访时Cobb角为（12．69±2．96）°；术后颈椎生理曲度均得到明显改善，但A组明显优于B组，两组间比较差异有统计学意义（P〈0．05）。[结论]两种手术方法治疗多节段脊髓型颈椎病均可取得满意的疗效，但ACDF具有并发症发生率低、出血量少、手术时间短等优点。

[ Objective ] The aim of this study was to compare 2 anterior surgical interventions for multi - segmental cervical spondylotic myelopathy. [ Methods ] We analyzed the clinical data from 65 patients who had undergone surgical interventions for three - segment spondylotic myelopathy between January 2008 and August 2011. The patients were divided into 2 groups based on the surgical intervention ： group A comprised 20 men and 7 women （ average age, 50. 43 ± 6. 50 years） who had undergone anterior cervical disceetomy with fusion （ACDF）, and group B comprised 25 men and 13 women （average age, 52. 31 ± 7.32 years） who had undergone anterior cervical corpectomy with fusion （ACCF） . There were no significant differences between the 2 groups. The incidence rates of complications, perioperative period, operative time, surgical blood loss, neurological function improvement rate, and improvement in the physiological curvature were assessed for both surgical interventions. [ Results ] All selected patients were followed for 13 - 34 months （average, 20 months） . Seven patients reported a variety of complications after the surgery, including 2 cases of bone graft fusion in group B （5.26%） . The bone graft nonunion rate in group B was significantly higher than that in group A （P 〈 0.05 ） . There was 1 case of hoarseness in group B （2. 63 % ） ; 2 cases of dysphagia, including 1 case in group A （3.70%） and 1 case in group B （2.63%） ; 1 case of cerebrospinal fluid leakage in group A; and 1 case of incision infection in group B. The incidence rates of complications were 7.40% in group A and 13.15% in group B; the incidence rate of postoperative complications in group B was significantly higher than that in group A （P 〈 0.05） . The operative times of the 2 groups were （ 107.9 ± 32.4） rain and （ 129 ± 23 ） min, respectively, with the comparison between the 2 groups being statistically significant （ P 〈 0. 05 ） . The surgical blood loss quantities in the 2 groups were （74. 6 ± 60. 8 ） ml and （ 147 ± 52） ml, respectively, with the comparison between the 2 groups being statistically significant （P 〈0. 05） . The neurological function improvement rates of the 2 groups were 76. 1% and 79.4%, respectively, and the comparison between the 2 groups was not statistically significant （P 〉0. 05） . The preoperative Cobb angle of group A was （7.78 ± 1.15 ）° and that at the last follow -up was （17. 82 ± 3.27）°, while the preoperative Cobb angle of group B was （8. 36 ± 2. 57）°and that at the last follow- up was （13.69 ± 2. 96）°. Postoperative cervical physiological curvature improved significantly in both groups; however, the improvement was significantly greater in group A than in group B. The comparison between the 2 groups was statistically significant （P 〈0. 05） . [ Conclusion] Both surgical methods can obtain a satisfactory curative effect in multi - segmental cervical spondylotic myelopathy. However, ACDF showed a lower incidence rate of complications, lesser blood loss, and shorter operative time compared with ACCF.