颈椎前路非融合术与前路融合术治疗颈椎病的中期疗效比较

Clinical outcome of mid-term follow-up of anterior cervical non-fusion surgery versus anterior cervical discectomy and fusion for cervical spondylosis

目的 评价颈前路人工椎间盘（Prodisc-C）置换术、颈椎动态稳定器（DCI）植入术和颈椎前路椎间盘切除减压融合术（ACDF）治疗颈椎病的临床效果.方法 纳入2011年5月至2013年5月首都医科大学附属北京朝阳医院骨科收治的44例退变性脊髓或神经根型颈椎病中老年患者,因治疗方式不同分为颈前路Prodisc-C人工椎间盘置换组、DCI植入组和ACDF组.对患者的性别、年龄、手术时间、出血量和平均住院日等基本情况进行分析,分别在术前、术后3、6、12和24个月对患者进行颈椎残障功能指数（NDI）、日本矫形外科协会（JOA）评分、颈部和上肢疼痛视觉模拟评分（VAS）.同时术前及末次随访通过X线片观察颈椎前凸角、手术节段和相邻节段椎间活动度以及椎间隙前后高度的变化情况.结果 所有患者均获得至少24个月随访.3组患者术后各随访时间点JOA、NDI、颈痛和上肢VAS评分较治疗前差异有统计学意义（P＜0.05）.非融合两组较ACDF组平均住院时间和各评分差异无统计学意义（P＞0.05）,但手术时间、术中出血量显著性降低（P＜0.05）.ACDF组颈椎活动范围术后明显降低（P＜0.05）,但非融合两组颈椎活动度治疗前后差异无统计学意义（P＞0.05）.两组非融合组较ACDF组颈椎前凸角和手术节段椎间活动度改变差异有统计学意义[（16.6±3.6）°,（22.3±4.6）°,（18.1±3.1）°,P ＜0.05],3组患者椎体前缘高度较术前显著改善[（7.0±1.0）mm,（9.2±1.5） mm,（6.8±1.4） mm,P＜O.05],但手术节段椎间隙后缘高度和邻近节段椎间活动度改变差异无统计学意义（P＞0.05）.3种手术方式均未出现严重的术后并发症.结论 颈椎非融合术和融合术治疗颈椎病中期随访均获得良好的临床疗效,Prodisc-C置换术和DCI植入术还能保持颈椎置换节段的活动度和稳定性,且对手术邻近节段活动度无明显影响,有望预防相邻节段退变的发生.

Objective To evaluate the clinical and radiological outcomes of artificial cervical disc replacement （Prodisc-C）,dynamic cervical implant and anterior cervical discectomy and fusion （ACDF） in the treatment of cervical spondylosis.Method From May 2011 to May 2013,a total of 44 cervical spondylosis patients that received cervical disc arthroplasty （Prodisc-C）,dynamic cervical implant （DCI） or ACDF were retrospectively reviewed in Orthopedics Department,Beijing Chaoyang Hospital,Capital Medical University.The patients were divided into three groups by surgical methods.Parameters as gender,age,the operation time,blood loss and average hospital stay of three groups were compared.The patients were followed 3 months,6 months,12 months and 24 months postoperatively.Neck disability index （NDI）,Japanese Orthopaedic Association （JOA） Score and Visual Analogue Scale （VAS） were used to evaluate the clinical outcomes of the three groups.We also measured the cervical lordosis,range of motion of surgical segment and adjacent segment and height of disc at pre-op and post-op.Result All the patients were got at least 24 months follow-up.The differences between postoperative JOA,NDI and VAS scores and preoperative scores were of statistical significance （P 〈 0.05）.There was no statistical difference in average hospital stay,JOA,NDI and VAS recovery rate （P 〉 0.05） among three groups.But the operative time and intraoperative blood loss were statistically different （P 〈 O.05）.Compared the pre-and postoperative ROM of C2-7,operative,upper and lower levels of each group respectively,the difference between pre-and postoperative ROM of ACDF group were of statistically significant [（16.6 ± 3.6） °,（22.3 ± 4.6） °,（18.1 ± 3.1） °,P 〈0.05],while was no statistically significant of non-fusion group （P 〉 0.05）.There was no statistically significant difference between pre-and postoperative ROM of upper and lower levels among three groups （P 〉0.05）,but had statistically difference in operative levels [（7.0 ± 1.0） mm,（9.2 ± 1.5） mm,（6.8 ±1.4） mm,P 〈 0.05].And there are no serious postoperative complications.Conclusion Two cervical nonfusion surgery and ACDF have received good clinical effects in the treatment of spondylotic myelopathy or radicular spondylosis.The artificial cervical disc replacement and dynamic cervical implant can not only recover cervical lordosis and keep the range of motion and stability of the surgical segment,but also reduce the incidence of compensatory motion at adjacent segments and will prevent from adjacent segment degeneration.