保留与切除钩椎关节在颈前路手术的临床效果比较

Comparison of clinical outcomes of anterior cervical discectomy and fusion with or without uncovertebral joint decompression

[目的]探讨颈前路减压植骨融合术(ACDF)中保留与切除钩椎关节减压治疗神经根型颈椎病患者的临床效果。[方法]回顾性分析2010年08月~2015年12月接受1个或者2个节段的颈前路减压椎间植骨融合内固定术的86例神经根型颈椎病患者,根据是否对钩椎关节椎间孔进行部分切除,29例患者列入钩椎保留组,57例患者列入钩椎减压组。采用日本骨科协会评分(JOA)评估治疗分数、颈椎功能障碍指数(NDI)评分、颈部及上肢疼痛视觉模拟评分(VAS)对治疗效果进行评价并比较。[结果]86例患者均顺利完成手术,术中未出现椎动脉损伤、神经根损伤及硬膜破裂情况。所有患者随访15~85个月,平均(20.2±3.6)个月。所有患者随访期间均达到骨性融合,钢板无松动。两组术后的JOA、VAS、NDI评分均较术前明显改善(P<0.05),两组间比较差异无统计学意义(P>0.05)。钩椎保留组优27.59%,良55.17%,一般13.79%,差3.45%;钩椎减压组优28.07%,良54.39%,一般14.04%,差3.51%.[结论]神经根型颈椎病患者在颈前路手术中,保留钩椎关节椎间撑开减压可获得与切除钩椎关节减压同样良好的临床效果。因此,神经根型颈椎病患者实施颈前路减压融合术(ACDF)不应常规切除钩椎关节。

[Objective] To compare clinical outcomes of instrumented anterior cervical discectomy and fusion （ACDF） with or without uncovertebral joint decompression in patients with cervical radiculopathy. [Methods] A retrospective study was con- ducted on the clinical data of 86 patients who underwent one- or two-level ACDF with rigid anterior plate fixation for treatment of cervical spondylotic radiculopathy from August 2010 to December 2015. According to whether or not the foraminal part of un- covertebral joint resected for decompression during the operation, the patients were divided into the uncovertebral decom- pressed group （57 patients） and the uncovertebral preserved group （29 patients） . The Japanese Orthopedic Association score （JOA）, neck disability index （NDI） and visual analogue score （VAS） were used to evaluate the clinical outcomes. [Results] The operations were successfully performed in all of the 86 patients. No injury of vertebral artery, injury of nerve root, dural rupture happened in any patient of both groups during operation. All the patients were followed up for 15-85 months with an average of 20.2＋3.6 months. Bony fusion achieved in all the patients with no plate loosening during the follow-up period. There were sta- tistically significant improvements in the JOA, NDI and VAS in both groups after the surgery （P〈O.05）, while without statisti- cal difference between the two groups at any corresponding time point. The clinical consequences were graded as excellent in 28.1%, good in 54.4%, fair in 14.0% and poor in 3.5% of the patients in the uncovertebral decompressed group, whereas excellent in 27.6%, good in 55.2% fair in 13.8% and poor in 3.4% of the uncovertebral preserved group. [Conclusion] This study demonstrates that ACDF with or without direct uncovertebral joint decompression does provide the similar good clinical results for cervical radiculopathy. Therefore, direct uncovertebral joint decompression need not be routinely conducted during ACDF.