显微镜与直视下ACDF治疗单节段脊髓型颈椎病的临床效果研究

Comparison of clinical outcomes after anterior cervical discectomy and fusion to single level cervical spondylotic myelopathy

目的对比分析颈椎前路椎间盘切除椎体间植骨融合(ACDF)术中是否应用显微镜技术治疗单节段脊髓型颈椎病的疗效。方法此研究为前瞻性随机对照研究,将76例单节段脊髓型颈椎病患者分为2组,显微镜组与非显微镜组38例。术后随访时间>2年,比较2组手术时间、出血量、并发症、住院天数及神经功能恢复情况。结果显微镜组与非显微镜组手术时间分别为(92.0±18.2)min和(78.0±14.3)min,术中出血量分别为(40.3±23.5)mL和(84.6±19.2)mL,2组比较差异有统计学意义(P<0.05),显微镜组手术时间长、出血量少。显微镜组与非显微镜组患者并发症、神经功能恢复情况间差异无统计学意义(P>0.05)。末次随访时,显微镜组与非显微镜组患者脊髓神经功能评分(JOA评分)改善率差异无统计学意义(P>0.05);2组并发症发生率差异无统计学意义(P>0.05),2组均未发生定位错误、大血管损伤和术后感染。结论 ACDF术中应用显微镜治疗单节段脊髓型颈椎病并未获得更好的远期疗效,虽然手术时间延长,但显微镜下行ACDF操作更精细、损伤小、术中出血少。

Objective The study was to assess the complications and long-term clinical outcomes between patients undergoing an Anterior Cervical Discectomy and Fusion（ ACDF） procedure with and without the use of an intra-operative microscope.Methods A prospective randomized controlled trial of 76 adult patients（ microscope group 38; non-microscope group 38） undergoing ACDF. Clinical results were assessed by operative time,estimated blood loss,Japanese Orthopaedic Association（ JOA） score and JOA recovery rate,Odom＇s standard. Clinical outcomes and complication rates were compared between the different groups. Results The duration of surgery was longer in the microscope cohort（ microscope 92. 0 ± 18. 2 min vs. non-microscope 78. 0 ± 14. 3 min,P 〈0. 05）.The estimated blood loss was more in non-microscope cohort（ microscope 40. 3 ± 23. 5 mL vs. non-microscope 84. 6 ± 19. 2 mL,P 〈0. 05）. There was no significant difference between cohorts in the Japanese Orthopaedic Association（ JOA） score and JOA recovery rate. Conclusions Our study demonstrates that the intra-operative use of a microscope does not improve overall surgery-related outcomes,nor does it lead to superior long-term outcomes in pain and functional disability.