ACDF钢板内固定术治疗多节段颈椎病的疗效分析

Study on conventional cage plate internal fixation in treating multi-level cervical spondylotic myelopathy

目的探讨颈椎前路椎间盘切除植骨融合术(ACDF)钢板内固定术治疗三节段颈椎病的临床效果。方法回顾性分析2012年1月至2015年1月收治的于我院行ACDF钢板内固定术治疗的三节段颈椎病患者37例。比较术前,术后以及末次随访时的VAS评分、JOA评分、NDI指数评估治疗效果;比较术前,术后以及末次随访时颈椎Cobbs角(CA)、融合节段Cobbs角(SA)以及融合椎体高度评估患者的颈椎曲度及高度变化情况;记录手术时间、术中出血量;观察患者并发症的发生;通过末次随访时颈椎动力位片观察植骨后融合情况。结果随访时间为11~32个月,VAS评分:术前6.76±2.02分,术后3.24±1.53分,末次随访时3.0±0.9分。JOA评分:术前9.71±1.66分,术后13.26±2.14分,末次随访时15.97±16.79分。NDI评分:术前30.68±8.46分,术后6.68±3.85分,末次随访时4.14±1.27分。SA:术前8.65°±11.03°,术后18.65°±8.68°,末次随访时18.26°±8.59°。CA:术前12.35°±12.86°,术后21.45°±9.92°,末次随访时21.43°±9.97°。术后,末次随访上述随访指标与术前差异有统计学意义(P<0.05),末次随访时与术后的差异无统计学意义(P>0.05)。术椎高度:术前70.44±1.64 mm,术后76.05±7.98 mm,末次随访时70.83±4.71 mm,术后术椎高度与术前差异有统计学意义(P<0.05),末次随访术椎高度与术前差异无统计学意义(P>0.05)。末次随访融合率为94.6%,发现1例患者出现神经根损伤;1例患者术后颈部血肿形成二次手术;3例患者出现术后吞咽困难但经治疗后改善;发现4例术后邻近节段退变,未发现内固定位置改变。结论 ACDF钢板内固定术治疗三节段颈椎病疗效肯定,具有满意的临床治疗效果和较高的植骨融合率。

Objective To discuss the clinical outcome of anterior cervical discectomy and fusion（ACDF）with internal fixation in treating multi-level cervical spondylotic myelopathy. Methods Thirty-seven cases suffer from multi-level cervical spondylotic myelopathy were treated with anterior cervical decompression and fusion with internal fixation by titanium plate in our hospital from Jan. 2012 to Jan. 2015. The clinical outcomes were evaluated by the parameters including improvement of Japanese Orthopaedic Association（JOA） score and neck disability index values（NDI）before operation,one months after operation and at the last follow up,measured cervical Cobb Angle（CA）and Segmental Angle（SA）on X-ray film. Record operation time,intraoperative blood loss,and the incidence of complications. Bony fusion was verified by X-ray at the final follow-up. Results The patients were followed up for 11 to 30 months. VAS scores were decreased from 6.76±2.02 preoperatively to 3.24±1.53 postoperation and 3.0 ± 0.9 at the final follow-up. JOA scores were increased from 9.71 ± 1.66 preoperatively to 13.26 ± 2.14 postoperation and 15.97 ± 16.79 at the final follow-up. NDI scores were decreased from 30.68±8.46 preoperatively to 6.68±3.85 postoperation and 4.14±1.27 at the final follow up. SA were increased from 8.65°±11.03° preoperatively to 18.65°±8.68° postoperation and 18.26°±8.59°at the final follow up. CA were increased from 12.35° ± 12.86° preoperatively to 21.45° ± 9.92°postoperation and 21.43° ± 9.97° at the final follow up. There were significant improvement for all postoperatively and at the final follow up compared with those preoperatively. There were no significant difference between postoperation and at final follow up for all. Height were increased from 70.44±1.64 mm preoperatively to 76.05±7.98 mm postoperation and 76.05±7.98 mm at the final follow up. There was significant improvement for postoperatively compared with that preoperatively. There were no significant difference between that at final follow up and preoperatively. Bony fusion rate was 94.6%,and one case complicated with nerve root injury,one case had a secondary surgery because of cervical haematoma,three had dysphagia after surgery but was improved after treatment,four cases had adjacent segment degeneration. No complications of internal fixation was found. Conclusion The clinical outcomes of anterior cervical decompression and fusion with internal fixation in treating MCSM is affirmative,and it makes spinal canal decompression and neurologic symptoms ease and fusion rate increase.