二种颈前路减压术治疗多节段脊髓型颈椎病疗效分析

目的：比较二种不同颈前路减压术式对治疗多节段脊髓型颈椎病的手术疗效及影像学结果。方法2008年5月至2011年11月行颈前路减压术治疗多节段脊髓型颈椎病98例，根据手术方式不同分为二组：前路颈椎间盘切除减压融合术（anterior cervical discectomy with fusion，ACDF）（A组）和前路椎体次全切减压融合术（anterior cervical corpectomy with fusion，ACCF）（B组）。所有患者术前、术后不同时期采用JOA评分评估神经功能情况，X线评价颈椎曲度、椎间高度变化情况。结果所有患者均获得术后17个月的随访。术后1个月、术后17个月JOA评分较术前之间差异均有统计学意义（P〈0.05），而组间比较差异无统计学意义（P〉0.05）。术后1个月、术后17个月COBB角、椎间高度与术前之间差异均有统计学意义（P〈0.05），但B组术后17个月COBB角、椎间高度与术后1个月之间差异有统计学意义（P〈0.05）。结论前路颈椎间盘切除减压融合术和前路椎体次全切除减压融合术均可有效地治疗多节段脊髓型颈椎病，但前路椎体次全切除减压融合术后颈椎稳定性比前路颈椎间盘切除减压融合术差。

Objective To investigate the clinical effect and image value of two anterior cervical decompression and fusion ways for multi-level of cervical spondylotic myelopathy. Methods 98 patients undergoing multi-level of cervical spondylotic myelopathy were devided into two groups（ACDF、ACCF）,named groupA and groupB respectively,groupA had 51 patients,groupB 47 patients.All patients,JOA、COBB、height of vertebral space value were compared respectively during different periods. Results All the patients were followed up seventeen months after the operation.There were significant differences in the JOA、COBB、eight of vertebral space value between preoperation and postoperation.But there were significant differences in the COBB、eight of vertebral space value between one month after operation with seventeen months after surgery. Conclusion both anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion cure multi-level of cervical spondylotic myelopathy efficiently,but anterior cervical corpectomy with fusion destroys the spine stability more than anterior cervical discectomy with fusion.