前路减压椎间植骨融合内固定术治疗神经根型颈椎病保留钩椎关节的可行性分析

Feasibility of anterior cervical decompression and fusion with retention of uncovertebral joint in the treatment of nerve root cervical spondylosis

目的研究前路减压椎间植骨融合术(Anterior cervical decompression and fusion,ACDF)治疗神经根型颈椎病术中保留钩椎关节的可行性。方法纳入2014年4月~2016年4月行ACDF治疗的72例神经根型颈椎病患者,将术中保留钩椎关节的32例患者设为观察组,切除钩椎关节的40例设为对照组。随访2年,比较两组患者临床疗效及,植骨融合情况。结果两组术后3个月、6个月、2年的NDI指数、VAS评分均显著低于治疗前,JOA评分显著高于治疗前,差异有统计学意义(P<0.05),但组间差异无统计学意义(P>0.05);观察组手术优良率为87.50%,对照组为90.00%,组间差异无统计学意义(P>0.05);两组吞咽不适、切口感染、慢性疼痛等并发症发生率差异无统计学意义(P>0.05);观察组的植骨融合效果略优于对照组,但差异无统计学意义(P>0.05)。结论 ACDF手术能显著改善神经根型颈椎病疼痛症状及颈椎功能,保留钩椎关节能获得与切除钩椎关节相同的近期疗效,且手术安全有效。

Objective To study the feasibility of anterior cervical decompression and fusion (ACDF) with retention of uncovertebral joint in the treatment of nerve root cervical spondylosis. Methods From April 2014 to April 2016, 72 patients with cervical spondylotic radiculopathy treated with ACDF were enrolled. Thirty-two patients with uncinate joint preservation during operation were selected as observation group, and 40 patients with uncinate joint resection were selected as control group. Following up for 2 years, the clinical efficacy and bone graft fusion were compared between the two groups. Results The NDI and VAS scores of the two groups at 3, 6 months and 2 years after surgery were significantly lower than before operation, and the JOA score was significantly higher than before treatment. The difference was statistically significant (P<0.05), but in each follow-up time after treatment, the difference between the two groups was not statistically significant (P>0.05). The Odom rate of excellent and good in the observation group was 87.50%, and that in the control group was 90.00%. There was no significant difference between the two groups (P>0.05). There were no significant differences in swallow discomfort, incision infection and the incidence of complications such as infection and chronic pain between the two groups (P>0.05). The bone fusion effect in the observation group was slightly better than that in the control group, but there was no significant difference between the two groups (P>0.05). Conclusion ACDF can significantly improve the pain symptoms and cervical function of cervical spondylotic radiculopathy. Retention of uncinate joint can achieve the same short-term effect as excision of uncinate joint, and the operation is safe and effective.