经椎间隙减压融合术与椎体次全切除治疗双节段颈椎病的临床研究

目的比较经椎间隙减压融合术（ACDF）与椎体次全切减压融合术（ACCF）治疗相邻两节段脊髓型颈椎病患者的临床疗效及邻近节段退变发生率的差异。方法回顾分析60例相邻两节段颈椎病患者，据手术方式分为2组，A组33例行ACDF术；B组27例行ACCF术，比较两组手术时间、术中出血量、JOA评分、颈椎曲度变化、融合节段椎间高度、植骨融合率、内固定失败率及邻近节段退变发生率的差异情况。结果所有患者均获得随访，时间36~72个月。A组手术时间长于B组，出血量少于B组，差异有统计学意义。两组术后JOA评分、融合节段高度及颈椎曲度与术前比较差异均有统计学意义；组间颈椎曲度及融合节段高度差异有统计学意义，但组间JOA评分比较差异无统计学意义。B组出现内植入物并发症，A组未出现。末次随访均达到骨性融合标准。按Hilibrand影像学标准，A组邻近节段发病率低于B组。差异有统计学意义。结论两种方法治疗双节段颈椎病均可获得满意的临床疗效。与ACDF比较，ACCF手术时间短，但手术创伤大、出血量多，在改善融合节段高度及颈椎曲度方面较差，有内固定失败现象，有较高的邻近节段退变发生率。

Objective Comparative study about clinical results and adjacent level degeneration of anterior cervical discectomy fusion （ ACDF ） or anterior cervical corpectomy fusion （ ACCF ） for the treatment of 2-level cervical spondylosis. Methods Retrospective comparative study of 60 consecutive patients treated with either anterior cervical discectomy fusion （ ACDF ） or anterior cervical corpectomy fusion （ ACCF ） for 2-level cervical spondylosis. In this series, 33 patients underwent 2-level ACDF （ Group A ） and 27 patients underwent ACCF （ Group B ） . Operative time, blood loss and JOA scores were noted, cervical sagittal curvature, fusion level heights, fusion rates, hardware failure and adjacent segment degeneration were measured. Comparative study of parameters between 2 group were analysed. Results All 60 patients were followed for 36-72 months. The operative time was significantly lower and blood loss significantly higher in Group B than in GroupA. Compared with pre-operative JOA scores, fusion level height and cervical sagittal curvature, Patients had significantly improvement ：But patients in both groups had equivalent improvement in JOA scores.Compared with group B, group A had significantly higher improvement in fusion level height and cervical Sagittal curvature.There is 1 srcew pull-out and 1 cage dislodgement in group B.Every patient had successful bone-fusion in the end.Follow the Hilibrand image criteria, the rate of ASD was significantly lower in group A than in Group B.Conclusions Both therapy can get good clinical outcome.Compared to ACDF, ACCF has shorter operative time, surgery trauma and more blood loss, poor improvement in fusion level height and cervical sagittal curvature, higher hardware morbidity and ASD incidence.