ACCF与ACDF治疗双节段脊髓型颈椎病的中期疗效及并发症随访分析

Analysis on the mid-term efficacy and follow-up visit of complications of ACCF and ACDF in the treatment of dual-segmental cervical spondylotic myelopathy

目的探讨前路椎体次全切钛网植骨融合内固定术(anterior cervical corpectomy and fusion,ACCF)与前路椎间盘切除Cage植骨融合内固定术(anterior cervical discectomy and fusion,ACDF)治疗相邻双节段脊髓型颈椎病的中期疗效及并发症发生情况。方法分析2010年1月～2014年12月期间共252例相邻双节段脊髓型颈椎病行颈前路减压融合内固定患者的临床资料,分为两组,ACCF组137例,ACDF组115例。比较两组患者手术时间、出血量、术前及术后日本矫形外科协会(Japanese orthopaedic association,JOA)评分、颈椎残障功能指数(Neck dis ability index,NDI)以及随访期间出现的并发症情况。结果两组人群手术时间及术中出血量无明显差异(P<0.05);随访过程中失访25例,其余均术后随访36个月。末次随访时,ACCF组患者JOA、NDI指数分别为(14.56±1.89)分,(6.26±1.29);ACDF组JOA、NDI指数分别为(14.28±1.78)分,(6.30±1.12),均较术前明显改善,但组间差异无统计学意义(P<0.05)。共有61例在术后36个月内出现并发症,发生率26.87%,其中ACCF组33例(包括吞咽不适2例,内固定相关并发症1例,邻近节段退变26例,融合失败1例,C_5神经根麻痹3例);ACDF组28例(伤口感染1例,吞咽不适1例,内固定相关并发症1例,邻近节段退变23例,融合失败1例,C5神经根麻痹1例)。结论两组手术方案在邻近双节段颈椎病的治疗上中期临床效果相当。ACDF组并发症发生率略高(26.9%vs 26.6%),但无明显统计学差异。ACDF组邻近节段退变发生率稍高,而ACCF组C_5神经根麻痹的发生率稍高。

Objective To analyze and compare the mid-term efficacy and complications of anterior cervical corpectomy and fusion（ACCF） and anterior cervical discectomy and fusion （ACDF） in the treatment of adjacent dual-segmental cervical spondylotic myelopathy. Methods The clinical data of 252 patients with adjacent dual-segmental cervical spondylotic myelopathy undergoing anterior cervical decompression and fusion internal fixation from January 2010 to December 2014 were analyzed and the patients were divided into two groups. There were 137 patients in ACCF group and 115 patients in ACDF group. The operation time, amount of blood loss, preoperative and postoperative Japanese orthopaedic association （JOA） scores, and neck disability index （NDI）, as well as the complications that occurred during follow-up visit were compared between the two groups. Results There was no significant difference in operation time and intraoperative blood loss between the two groups（P〈0.05）; during follow-up visit, 25 patients were lost to follow-up, and the rest were followed up for 36 months after surgery. At the final follow-up visit, the JOD and NDI index in the ACCF group were （14.56±1.89） and （6.26±1.29） respectively; the JOA and NDI index in the ACDF group were （14.28±1.78） and（6.30±1.12） respectively. All of them were significantly improved compared before surgery（P〈0.05）, but there was no statistically significant difference between the two groups. A total of 61 patients had complications within 36 months after operation, with the incidence rate of 26.87%. There were 33 cases in ACCF group （including 2 cases of swallowing discomfort, 1 case of internal fixation-related complications, 26 cases of adjacent segment degeneration, 1 case of fusion failure, and 3 cases of C5 nerve root palsy）. There were 28 patients in the ACDF group （1 case of wound infection, 1 case of swallowing discomfort, 1 case of internal fixation-related complications, 23 cases of adjacent segment degeneration, 1 case of fusion failure, and 1 case of C5 nerve root palsy）. Conclusion The two groups of surgical plans have similar clinical effects in the treatment of adjacent dual-segmental cervical spondylosis. The incidence rate of complications in the ACDF group is slightly higher（26.9% vs 26.6%）, but there is no statistically significant difference. The incidence rate of adjacent segmental degeneration in the ACDF group is slightly higher, while the incidence rate of C5 nerve root palsy in the ACCF group is slightly higher.