人工颈椎间盘置换联合颈前路融合术治疗多节段脊髓型颈椎病

Treatment on multilevel cervical spondylotic myelopathy by artificial cervical disc replacement combined with anterior cervical discectomy and fusion

目的：评价人工颈椎间盘置换联合颈前路融合术治疗多节段脊髓型颈椎病的临床效果。方法采用人工颈椎间盘置换联合颈前路融合治疗18例多节段脊髓型颈椎病患者。根据术前、术后、随访时的颈椎X线片观察人工椎间盘、内固定、植骨融合以及JOA评分改善情况。结果18例均获随访，时间24-60（36±9．6）个月。置换间隙平均活动度术前为13．8°±6．5°，末次随访时为12．5°±5．3°，与术前比较差异无统计学意义（P〉0．05）。 JOA评分术前为9．5分±1．5分，术后4个月时为14．2分±2．2分，平均改善率62．7%±11．2%，其中优9例，良5例，可2例，差2例。所有病例内置物无松动、移位及断裂，人工椎间盘位置良好。结论人工颈椎间盘置换联合颈前路融合术治疗多节段脊髓型颈椎病能维持颈椎活动度，减少固定融合节段，同时又减少邻近节段运动负荷。

Objective To explore the clinical effects of artificial cervical disc replacement（ ACDR） combined with anterior cervical discectomy fusion （ ACDF ） for the treatment of multi-segmental cervical spondylotic myelopathy （ CSM） . Methods 18 cases with multi-segmental CSM which were treated by ACDR combined with ACDF were re-viewed. The stability of artificial disc, internal fixation and bone fusion were evaluated by X-ray films before opera-tive, immediate postoperative and follow-up. The JOA scores was evaluated also at the same time. Results 18 pa-tients were followed up from 24 to 60 months （ averaged 36 ± 9. 6 months） . The range of motion of the replacement segment were 13. 8° ± 6. 5° at preoperative and 12. 5° ± 5. 3° at the final follow-up, and there was no significant difference between them（P〉0. 05）. The preoperative JOA scores was 9. 5 ± 1. 5, which was improved to 14. 2 ± 2. 2 in 4 months after operation; Preoperative neurological symptoms were obviously alleviated in most patients, and the improvement ratio of JOA was 62. 7% ± 11. 2%. The results were excellent in 9 patients, good in 5, fair in 2 and poor in 2. There were no patient with false of internal fixation, and the position of artificial disc was good. Conclu-sions ACDR combined with ACDF is a good procedure for multi-segmental cervical spondylotic myelopathy, it not only maintain the cervical spine alignment with saving more movement segments,but also reduce the incidence of ad-jacent segment degeneration.