颈前路杂合与多节段融合术治疗多节段颈椎病的比较

Hybrid surgery versus multi-level fusion for treatment of multi-level cervical spondylopathy

[目的]比较颈前路杂合术式和颈前多节段椎间盘切除融合术治疗多节段颈椎病的中期疗效。[方法]回顾性分析2010年4月~2014年10月,62例连续累及3个节段的颈椎病患者的临床资料,其中,26例患者接受上、下节段人工椎间盘置换联合中间融合术(杂合组),36例患者行前路连续3个病变节段椎间盘切除融合术(融合组)。临床功能评估采用疼痛视觉模拟评分(VAS)、颈椎功能障碍指数(NDI)、日本矫形外科协会(JOA)评分。此外,影像学测量C_(2-7)的活动范围(ROM)。[结果]两组患者性别、年龄、病变节段、病变类型及随访时间的差异无统计学意义(P>0.05),两组患者术前基线资料具有可比性。两组患者术后JOA、NDI、VAS评分均较术前有明显改善。两组患者C_(2-7)节段的ROM在术后第1、6个月与术前相比明显减小,差异有统计学意义(P<0.05),但杂合组在第12个月和末次随时均恢复到术前水平,融合组直到末次随访时未能恢复至术前水平,术后1、6、12个月及末次随访时杂合组手术节段活动度均显著优于融合组,两组间差异均有统计学意义(P<0.05)。[结论]对于多节段颈椎病的患者,杂合术式可能是一种安全、有效、可以替代颈前多节段融合术的手术方式,不但可以有效改善神经症状,而且可保持颈椎的术前运动范围和稳定性,中期随访结果令人满意。

[Objective] To compare the clinical and radiological outcomes of artificial disk replacement plus cervical fu- sion （the hybrid procedure） versus multi-segment anterior cervical diskectomy fusion （ACDF） for treatment of multi-level cervical spondylopathy. [Methods] This retrospective study was eondueled on clinical data of 62 patients with cervical spon- dylopathy continuously involving three levels receeived surgical treatment from April 2010 to October 2014. Of them, 26 patients underwent hybrid procedure （tile hybrid group） , which was combination of upper and lower artificial disk replacements with middle ACDF, whereas 36 patients received ACDFs at the continuous three levels involved （the fusion group） . Visual analogue scale （VAS） , Neck Disability Index （NDI） and Japanese Orthopaedic Association （JOA） score were used for evaluation. In addition, angular range of motion （ROM） for C2-7 measured radiologically was compared between two groups. [Re- suits] There was no statistically significant differences between the two groups in terms of the gender, age, involved segment, and lesion type betbre the surgery （P〉0.05） . All the patients were followed up for at least 24 months. The VAS, NDI and JOA scores in both two groups significantly improved after operation （P 〈 0.05 ） . In addition, ROM of the C2-7 segments significantly decreased at 1, 6 months postoperatively compared to those preoperatively in both groups （P 〈 0.05） . However, the mean C2-7 ROM in the hybrid group recovered to the preoperative level at 12 months and the latest follow-up, whereas that in the fusion ACDF group did not return at the latest follow-up. The hybrid group was statistically superior to the fusion group in affected segment mobility at 1, 6, 12 months and the latest follow up （P〈0.05） . [Conclusion~ For treatment of multi-level cervical spondylopathy, the hyt^rid procedure with advantage of preserving mobility of the affected spine does achieve satisfactory mid-term outcome. It is an effective alternative of muhi-segment ACDF surgery.