3种前路术式治疗相邻两节段脊髓型颈椎病的疗效分析

Analysis of curative effect for three anterior approaches in treatment of adjacent two segments cervical spondylotic myelopathy

目的分析3种前路减压方式治疗相邻两节段脊髓型颈椎病的临床疗效。方法选择2009年3月-2016年1月新疆医科大第六附属医院收治的89例相邻两节段脊髓型颈椎病患者,分别采用颈椎前路椎体次全切植骨内固定术（ACCF）、保留后壁的ACCF和颈椎前路减压椎间融合钛板内固定术（ACDF）治疗,记录3组手术时间、术中出血量及术前术后JOA评分,并比较其差异。术前2 w建议患者练习将气管食管推向健侧。术后3组均行颈托固定,随访12~36个月,定期行CT扫描重建测量椎间高度,观察融合效果。结果 ACDF组手术的用时短,术中出血量少,明显优于其余2组,差异均有统计学意义（P〈0.05）,但3组术前、术后JOA评分差异无统计学意义（P〉0.05）,89例相邻两节段脊髓型颈椎病患者中术后6个月共71例在ASIA分级上达到E级,临床效果明确。所有患者中仅有1例分级为B级,无明显改善。结论 ACCF、保留后壁的ACCF及ACDF均取得了满意的临床效果。

Objective To observe and analyze the clinical efficacy of three anterior approaches in treatment of cervical spondylosis of adjacent two segments. Methods From March 2009 to January 2016,a total of 89 cases of two adjacent segments of the cervical spondylotic myelopathy patients were treated at the sixth affiliated hospital of Xinjiang medical university,using the anterior cervical subtotal resection of vertebral body bone fixation（ ACCF）and anterior cervical decompression,interbody fusion and titanium plate internal fixation（ ACDF）,respectively.The operation time,operation in preoperative blood and postoperative JOA score of three groups were recorded and compared. 2 weeks before the operation,the patients were recommended to do the exercises to push the trachea and esophagus to the healthy side. After the operation,the three groups were fixed neck with neck splint. The patients were followed up for 36 to 12 months. The postoperative CT scan was performed to observe the fusion effect. Results The curative effect of group ACDF surgery with short time,less bleeding were significantly better than that of the other two groups,and the differences were statistically significant（ P〈0 05）,while there were no significant differences in JOA score of three groups before operation and after operation（ P〈0 05）. After 6 months,in 89 patients with two adjacent segments of cervical spondylotic myelopathy,treatment effect of a total of 71 cases may reach E level in ASIA classification,so the clinical effect is clear. In all the patients,only 1 cases had no significant improvement with grade B. Conclusion Both ACCF and ACDF achieved satisfactory clinical results.