颈椎动态稳定器置入术与颈椎前路椎间盘切除减压植骨融合术治疗单节段颈椎病的临床效果

Clinical effect of dynamic cervical implantversus and anterior cervical diskectomy and fusion in the treatment of single-level cervical degenerative disc disease

目的探讨颈椎动态稳定器置入术(DCI)与颈椎前路椎间盘切除减压植骨融合术(ACDF)治疗单节段颈椎间盘退变引起的脊髓或神经根颈椎病的临床效果。方法纳入武汉大学人民医院2013年3月~2014年8月收治的60例单节段颈椎退行性椎间盘疾病患者,按照其手术方式的不同,分为DCI组(24例)和ACDF组(36例)。临床评价指标主要如下:两组手术时间、术中出血量;两组术前、术后3,12个月颈部的视觉模拟评分(VAS-N)和上肢疼痛评分(VAS-A),颈部疼痛与残疾量表(NPAD),欧洲五维健康量表(EQ-5D)。影像学结果包括:手术邻近节段活动度(ROM)、颈椎整体角度(C_(2~7)Cobb角)结果。结果 DCI组手术时间及出血量均明显低于ACDF组(P<0.05)。DCI组和ACDF组术后临床疗效随访12~18个月,平均14.6个月。VAS-N、VAS-A、NPAD评分和EQ-5D评分:两组术后3、12个月随访结果与术前相比,差异均有统计学意义(P<0.05),临床疗效明显;但两组间差异无统计学意义(P>0.05)。DCI组术后ROM较术前无明显改变(P>0.05);ACDF组术后12个月ROM较术前明显增加(P<0.05);DCI组术后12个月较ACDF组减小(P<0.05)。ACDF组术后3个月C_(2~7)Cobb角与术前比较,差异有统计学意义(P<0.05),术后12个月与术前比较,差异无统计学意义(P>0.05)。结论 DCI与ACDF治疗单节段颈椎病在中短期随访中临床效果满意。DCI能有效保留手术节段的活动度,与ACDF相比,能更好地保护脊柱的运动。

Objective To evaluate clinical outcome of dynamic cervical implant versus（DCI） or anterior cervical diskectomy and fusion（ACDF） in the treatment of cervical spinal cord or cervical spondylotic myelopathy caused by single-level cervical degenerative disc disease. Methods 60 patients with single-level cervical degenerative disc disease in Renmin Hospital of Wuhan University from March 2013 to August 2014 were divided into DCI group（24 cases）and ACDF group（36 cases） according to their different surgical methods. The operation time, bleeding volume, the visual analog scale for neck（VAS-N） and the arm pain（VAS-A）, the neck pain and disability scale（NPAD） and the European quality of life scale（EQ-5D）, surgery adjacent segmental mobility（flexion and extension angle） and operative segmental cervical vertebra activity（ROM） before after operation were observed. Results The operation time and bleeding volume of the DCI group were significantly lower than those of the ACDF group（P〈0.05）. DCI group and ACDF group were followed up for 12-18 months, 14.6 months on average. The VAS-N, VAS-A, NPAD and EQ-5D scores were statistically significant in the two groups before and after operation（P〈0.05）, and the clinical outcome was significant. But there was no significant difference between the two groups（P〈0.05）. There was no significant difference in the ROM of DCI group before and after operation（P〈0.05）; however, the ROM of the ACDF group was increased 12 months after operation（P〈0.05）, which was higher than DCI group（P〈0.05）. The cobb angle in the ACDF group 3 months after operation had significant difference compared with before operation（P〈0.05）, while the cobb angle in the ACDF group 12 months after operation had no significant difference compared with before operation（P〈0.05）. Conclusion DCI and ACDF treatment of single segment cervical spondylosis in the short-term follow-up clinical results are satisfactory. DCI can effectively retain the activity of the surgical segment and protect the movement of the spine compared with ACDF.