前路椎间盘切除减压融合固定治疗两节段脊髓型颈椎病

Anterior cervical discectomy and fusion in the treatment of cervical spondylotic myelopathy

目的观察前路椎间盘切除减压椎间融合器植骨融合钛板内固定术(ACDF)治疗连续型两节段脊髓型颈椎病的疗效。方法采用ACDF治疗38例连续型两节段脊髓型颈椎病患者。在颈椎X线片上测量融合节段Cobb角、融合节段高度,观察植骨融合情况。采用JOA评分对手术前后神经功能进行评估。结果患者均获得随访,时间11～26个月。术后6～8个月椎间隙植骨均获得骨性融合。融合节段Cobb角:术前为5. 7°±3. 4°,术后3 d为8. 8°±2. 7°,末次随访为8. 1°±1. 9°。融合节段高度:术前为53. 2 mm±2. 5 mm,术后3 d为57. 7 mm±3. 3 mm,末次随访为56. 9 mm±2. 6 mm。JOA评分:术前为7. 8分±2. 2分,术后3 d为12. 4分±2. 6分,末次随访时为13. 0分±2. 1分。上述3项指标术后3 d及末次随访与术前比较差异均有统计学意义(P <0. 05),末次随访与术后3 d比较差异均无统计学意义(P> 0. 05)。结论 ACDF治疗连续型两节段脊髓型颈椎病能维持融合节段高度,临床疗效满意。

Objective To investigate the clinical effect of anterior cervical discectomy and fusion(ACDF)in the treatment of two-level adjacent cervical spondylotic myelopathy.Methods Thirty-eight cases of two-level adjacent cervical spondylotic myelopathy were treated by ACDF,imaging studies were performed before and after operation,including fusion segment Cobb angle and fusion segment height,situation of fusion after bone transplantation,JOA score was used to evaluate the clinical effects before and after the operation.Results The 38 cases were followed up,the time ranged from 11~26 months.Bony fusion was obtained in all patients in 6~8 months postoperatively.The Cobb angle were 5.7°±3.4°,8.8°±2.7°,and 8.1°±1.9°at the preoperation,3 days after operation and last follow-up,respectively.The preoperative fusion segment height was 53.2 mm±2.5 mm,3 days after operation,fusion segment height was 57.7 mm±3.3 mm,at the last follow-up,fusion segment height was 56.9 mm±2.6 mm.The preoperative JOA score was 7.8±2.2,3 days after operation,JOA score was 12.4±2.6,at the last follow-up,JOA score was 13.0±2.1.Cobb angle,fusion segment height,JOA score showed significantly statistical difference preoperation and postoperative 3 days(P<0.05),and there was no significant difference in above items between postoperative 3 days and last follow-up(P>0.05).Conclusions ACDF in the treatment of two-level adjacent cervical spondylotic myelopathy can maintain the fusion segment height of cervical spine,which can obtain a satisfactory clinical efficacy.