颈前路融合术后相邻节段病诊治分析

Treatment and analysis of adjacent segment disease after anterior cervical vertebrae fusion

目的探讨颈椎前路减压融合术后相邻节段病(ASD)的发病因素、治疗方法及疗效。方法将随访时间≥3年的451例行颈前路融合术患者(1节段189例,2节段176例,3节段71例,>3节段15例)根据是否再发与影像学一致的颈椎病的临床表现分为ASD组与非ASD组。比较两组年龄、性别、内固定与否、JOA评分、D值、融合节段分布、融合节段数的差异。同时对非手术治疗无效的ASD患者行颈椎前路减压融合术治疗,采用JOA评分和D值对ASD术后疗效进行评价。结果患者均获得随访,时间3～15年,共有46例出现ASD。ASD组与非ASD组在年龄、性别、JOA评分、融合节段分布、融合节段数比较差异均无统计学意义(P>0.05);在钢板内固定与否、D值改变两项比较差异有统计学意义(P<0.05)。对21例非手术治疗无效的ASD患者行颈前路手术,患者术后随访15～86个月,均获得骨性融合,未见顽固性并发症,末次随访时JOA评分为14.24分±2.17分,比术前的9.14分±1.22分升高(P<0.05);末次随访时D值为5.33 mm±3.61mm,比术前的1.78 mm±1.49 mm增加(P<0.05)。结论 ASD的发生与颈椎前路手术中钢板使用和颈椎曲度恢复不良有关,对于非手术治疗失败的ASD患者采用颈椎前路减压融合术治疗可取得满意效果。

Objective To investigate the pathogenesis,treatment method and clinical outcome of adjacent segment disease（ ASD） after anterior cervical vertebrae fusion. Methods The 451 cases（ 189 cases of single-segment fusion,176 cases of double-segment fusion,71 cases of triple-segment fusion and 15 cases of 3 segments fusion） who received anterior cervical vertebrae fusion and followed up for no less than 3 years,were retrospectively collected,according to recurrent clinical manifestation of cervical spondylosis consistent with radiographic findings or not in the follow-up period,the patients were divided into ASD group and non-ASD group. There was an analysis of difference in age,sex,internal fixation or not,JOA scores,the D value,distribution of fused segments and numbers of fused segment between the two groups; anterior cervical decompression and fusion were carried out in those whose conservative treatment failed in ASD group,postoperative effect was analyzed by JOA scores and the D value in operated ASD group. Results There were 46 ASD cases in the follow-up period of 3 ～ 15 years. Compared with non-ASD group,ASD group had significant difference in plate internal fixation and the D value（ P 0. 05）,but no in age,sex,JOA scores,distribution of fusion segments and numbers of fused segment（ P 0. 05）. Twenty-one cases of 46 in ASD group who failed in conservative treatment were manipulated by anterior cervical decompression and fusion,and followed up from 15 months to 86 months after the revision surgery,no intractable complication was found,the JOA scores of 14. 24 ± 2. 17 and the D value of 5. 33 mm ± 3. 61 mm in the final follow-up made a significant difference compared with 9. 14 ± 1. 22 and 1. 78 mm ± 1. 49 mm before the revision surgery respectively（ P 0. 05）. Conclusions The development of ASD is associated with the use of plate and the poor recovery of cervical curvature after anterior cervical fusion. Anterior cervical decompression and fusion is effective for the treatment of ASD after the failure of the conservative therapy.