两种前路减压融合方式治疗双节段脊髓型颈椎病的疗效分析

Curative effect analysis of two kinds of anterior decompression and fusion methods for double cervical spondylotic myelopathy

目的比较前路椎间盘切除植骨融合并钛板置入内固定术(ACDF)及前路椎体次全切除植骨融合并钛板置入内固定术(ACCF)对相邻双节段脊髓型颈椎病的疗效。方法选择我院收治的76例双节段脊髓型颈椎病患者作为研究对象,将其随机分为ACCF组和ACDF组,观察2组患者围手术期相关指标、脊髓功能、颈椎正侧位和屈伸动力位X线片检查,记录Cobb’s角及融合节段高度并评价植骨融合情况。结果 2组患者手术相关指标结果显示,ACDF组患者的手术时间、出血量、住院时间等指标明显优于ACCF组(P<0.05),2组患者的植骨融合率均为100%;2组患者术后融合节段高度无显著差异,P>0.05;ACDF组在术后Cobb’s角改善程度明显优于ACCF组(P<0.05)。结论 ACCF和ACCG治疗双节段脊髓型颈椎病效果比较满意,其中ACDF具有手术时间短、出血量少、融合节段Cobb’s角改善程度明显及并发症少等优点。

Objective To investigate the effect of anterior cervical discectomy and interbody fusion （ACDF） combined with titanium plate fixation technique and subtotal vertebrectomy and fusion and titanium plate internal fixation operation （ACCF） on adjacent segmental cervical spondylotic myelopathy. Methods 76 patients with double segment spondylotic cervical myelopathy were randomly divided into AC- CF group and ACDF group, the relevant indicators of operation period, spinal cord function, anteroposterior and lateral of cervical spine and flexion-extension dynamic radiographs were observed, the Cobb＇ s angle and fusion segmental height and bone fusion were recorded. Results The operation related index results showed that the operation time, bleeding volume and hospitalization time of patients in ACDF were less than those in ACCF group （ P 〈 0.05 ）. The bone graft fusion rate of two groups was 100%. There was no significant differences in postopera- tive fusion segment height between two groups （P 〉 0.05）. The postoperative Cobb＇ s angle degree of ACDF group is better than that of AC- CF group （P 〈 0. 05）. Conclusion The effect of ACCF and ACCF on the treatment of two-level CSM were satisfactory, of which ACDF has the advantages of short operation time,less bleeding, fusion segments of Cobb＇ s angle and fewer complications.