单节段双节段颈椎融合术后颈椎活动度的观察

Motion changes of cervical range after one or two-level cervical spine fusion

目的：探讨单节段及双节段颈椎融合手术对颈椎活动度的影响。方法：选取2010年6月～2012年6月在皖南医学院附属弋矶山医院脊柱外科行颈椎前路减压融合术的43例颈椎病患者，其中单节段融合29例，双节段融合14例。根据症状及x线片评价手术的有效率及融合节段的融合率。使用颈椎活动度测量仪（cervical range of motion device，CROM）测量患者术前及术后随访24个月时颈椎前屈、后伸、左右侧弯、左右旋转6个方向的活动度。结果：从患者主诉分析，所有患者临床症状均得到缓解，通过X线评价融合节段融合率为100％。与术前相比单节段融合术后患者颈椎左右侧弯方向活动度无明显差异（P〉0．05），而在前屈、后伸及左右旋转方向的活动度均较术前明显减低（P〈0．05）。行双节段融合手术后患者颈椎在6个方向的活动度较术前均明显减低（P〈0．05）。对两种不同融合术后患者颈椎活动度的差异进行统计学分析后发现双节段融合患者术后颈椎活动度在6个方向均较单节段融合患者降低（P〈0．05）。结论：颈椎融合手术能够降低患者颈椎的活动度，与单节段融合相比双节段融合术后颈椎活动度的降低更为明显。

Objective ： To observe the impact of one or two-level and double-level cervical spine fusion on the rang of cervical motion. Methods ： Forty-three patients undergone cervical spine fusion in our department between June of 2010 and 2012 were included, among whom 29 received single-level fusion, and 14, two-level fusion. The curative effects and fusion rate of spine were evaluated by presented symptoms and X-ray findings. The cervical flexion, backward extension, left and right lateral bending,left and right rotation of the cervical vertebrae were measured by the cervical range of motion device （CROM） in all patients before operation and post-operative 24-month follow-up. Results ：The clinical symptoms were alleviated and segmental fusion rate arrived at 100% by X-ray imaging. In single-level fusion group, cervical range of motion by left and right lateral bending showed no significant difference after surgery（ P 〉 0. 05 ）, yet post-operative cervical flexion, backward extension,left and right rotation of the cervical vertebrae were significant in all patients（ P 〈 0. 05 ）. In two-level cervical spine fusion group, cervical range of motion after cervical fusion was significantly lower in six directions compared to pre-operation （P 〈 O. 05 ）. The differences of two surgical options indicated that cervical range of motion was obviously reduced in six directions in patients received two-level cervical spine fusion （ P 〈 0. 05 ）. Conclusion ： The cervical spine fusion may reduce the range of motion, yet two-level cervical spine fusion can lead to bet- ter outcome than the one-level segment fusion.