双节段颈椎间盘置换术与双节段前路植骨融合术的临床疗效比较

Comparison of clicical effect between 2 level cervical disc replacement and 2 level anterior bone graft fusion

目的探讨双节段颈椎间盘置换术与双节段前路植骨融合术的临床疗效差异。方法收集双节段颈椎病患者58例，随机分为两组，双节段颈椎间盘置换术组23例，双节段颈前路植骨融合组35例。分别记录两组手术时间、术中出血量及术后并发症情况。观察颈椎总活动度（ROM）及颈椎功能障碍指数（NDI）变化。结果双节段植骨融合组手术时间显著少于双节段颈椎间盘置换组（P〈0．01），两组患者手术出血量差异无统计学意义（P〉0．05）。两组患者术中、术后均无严重并发症出现。术前两组患者颈椎后凸率分别为17．39％和17．14％，差异无统计学意义（P〉0．05），末次随访时两组颈椎后凸率分别为13．04％和42．85％，差异有统计学意义（P〈0．05）。术前两组患者颈椎ROM分别为（27．6±13．5）°和（29．9±16．4）°，差异无统计学意义（P〉0．05），末次随访时两组颈椎ROM分别为（23．8±14．2）°和（10．5±11．2）°，差异有统计学意义（P〈0．05）。手术前后两组患者NDI评分差异无统计学意义（P〉0．05）。结论与双节段前路融合手术比较，双节段颈椎间盘置换具有关节重建的优势，可保留手术节段活动度，维持颈椎生理曲度及颈椎总活动度，从而减少邻近节段退变的发生。

Objective To analyze the differences of clicical effect between 2 level cervical disc re- placement and 2 level anterior bone graft fusion. Methods 58 cases of 2 level cervical spondylosis were collected from February 2009 to February 2012, who were randomly divided into two groups, 23 cases were with 2 level cervical disc replacement and 35 cases were with anterior bone graft fusion. The operation time, blood loss and postoperative complications of the two groups were recorded. Neck disable index （NDI） and total segmental range of motion （ROM） were evaluated. Results The operation time of 2 lev- el cervical disc replacement was significantly less than 2 level bone graft fusion group （ P 〈 0. 01 ）, two groups of patients with blood loss no statistical difference （ P 〉 0.05 ）. No statistical difference was detec- ted between two groups with respect to blood loss （ P 〉 0. 05 ）. The preoperative kyphosis rates of two groups were 17.39% and 17. 14% respectively, there was no statistically significant difference （P〉 0.05 ）, while the kyphosis rates of two groups at last follow- up were 13.04% and 42. 85% respectively, the difference was statistically significant （ P 〈 0. 05 ）. The preoperative cervical ROM were （ 27. 6 ± 13.5）° and （29. 9 ± 16. 4）° respectively, there was no statistically significant difference （P 〉 0. 05）, the cervical ROM at last follow - up were （23.8± 14. 2 ）° and （ 10. 5 ± 11.2）° respectively, the difference was statistically significant （P 〈 0. 05）. No statistical difference was detected between two groups with re- spect to preoperative and last follow - up NDI scores （P 〉 0. 05）. Conclusion Compared with 2 level anterior bone graft fusion, 2 level cervical disc replacement has the advantages of joint reconstruction, reten- tion of segmental mobility and range of cervical motion, thereby reducing the occurrence of adjacent segment degeneration.