两种颈前路手术方式治疗双节段颈椎病

Discectomy versus corpectomy in treatment of 2-level cervical spondylosis

[目的]比较两种颈前路术式治疗双节段颈椎病的疗效。[方法]回顾性分析2010~2014年52例双节段颈椎病患者的临床资料,其中颈前路椎体次全切减压＋钛网植骨融合内固定术治疗29例（ACCF组）,颈前路双节段椎间盘切除减压＋Cage植骨融合内固定术治疗23例（ACDF组）。t检验比较两组平均失血量、平均手术时间、NDI评分。方差分析法比较术后JOA评分改善率、内固定沉降率。[结果]ACCF组平均随访时间（25±2.3）个月,ACDF组为（26±1.9）个月。两组患者神经症状均较术前明显改善,JOA评分及术后2年植骨沉降率差异无统计学意义。两组术中平均失血量、平均手术时间、术后2年NDI评分方面差异有统计学意义。平均失血量：ACCF组为（176±28.2）ml,ACDF组（65.7±16.7）ml,P=0.015;平均手术时间：ACCF组为（70±11.2）min,ACDF组（99±15.6）min,P=0.023;术后2年NDI评分：ACCF组为（9.3±3.3）,ACDF组（5.2±1.1）,P=0.019。[结论]除非出现病椎平面后方较大致压物,双节段ACDF组不能彻底减压的情况,双节段ACDF术式较单节段ACCF更具优势。

[Objective] To assess and compare the clinical effects of two methods of anterior cervical decompression and reconstruction for the treatment of 2-level cervical spondylosis. [Methods] Between 2010 to 2014,52 patients underwent surgical treatment for cervical spondylosis,including 29 who underwent ACCF（ anterior cervical corpectomy auto-graft fusion）and 23 who underwent ACDF（ anterior cervical discectomy auto-graft fusion）. The parameters that we recorded during and after operation included blood loss,operation time,JOA score,NDI score and imaging performance. The data was compared with Student＇s T-test or ANOVA. [Results] The mean durations of follow-up were（ 25 ± 2. 3） months（ ACCF） and（ 26 ±1. 9） months（ ACDF）. All the patients had a satisfying neurologic outcome improvement. There were no significant differences in JOA score and sedimentation rate of internal fixation during the follow-up period between the two groups. There were significant differences in blood loss,operation time,and NDI score during the follow-up period between the two groups. The blood loss was significantly more in ACCF than in ACDF group（ 176 ± 28. 2ml and 65. 7 ± 16. 7ml per segment,respectively,P =0. 015）. The operation time was significant shorter in ACCF than in ACDF group（ 70 ± 11. 2 min and 99 ± 15. 6 min per segment,respectively,P = 0. 023）. The NDI score was significant higher in ACCF than in ACDF group（ 9. 3 ± 3. 3 and 5. 2 ±1. 1,respectively,P = 0. 019）. [Conclusion] Anterior cervical discectomy auto-graft fusion with internal fixation is the optimal surgical approach for 2-level cervical spondylosis only when there is large compression in the spinal cord behind vertebra body and can＇t be removed.