颈椎前路减压融合术联合钩椎关节部分切除在神经根型颈椎病治疗中的应用

Application of ACDF combined with partial resection of uncinate joint in the treatment of cervical spondylotic radicular disease

目的评价颈椎前路减压融合术(anterior cervical decompression and fusion, ACDF)联合钩椎关节部分切除术治疗神经根型颈椎病的临床疗效。方法回顾性分析2013年9月至2017年7月我科收治并进行手术的神经根型颈椎病病人76例,平均年龄为47.2岁;其中男43例,女33例。行ACDF联合钩椎关节部分切除者49例,纳入联合组;行单纯ACDF手术者27例,纳入单纯ACDF组。对其手术时间、术中出血量及手术前后C2~C7Cobb角、颈部及上肢疼痛视觉模拟量表(visual analogue scale, VAS)评分、颈椎功能障碍指数(neck disability index, NDI)、植骨融合情况等进行统计分析,评价并比较两种手术方式的疗效。结果随访时间为12~24个月,平均18个月。联合组1例病人出现C5神经根麻痹,余均无明显的神经功能损害等严重并发症;1例术后伤口内血肿,予以再次手术清除血肿。联合组手术时间为(123.74±10.19)min,术中出血量为(343.93±72.29)ml;单纯ACDF组手术时间为(108.00±10.50)min,术中出血量为(299.40±49.31)ml。所有病人术后Cobb角较术前明显增大,末次随访时Cobb角未见明显丢失;所有病人术后、末次随访时的VAS评分、NDI均较术前明显改善;两组间术前、术后及末次随访时的VAS评分比较,差异均无统计学意义(P均>0.05),但联合组术后的VAS评分优于单纯ACDF组;而联合组术后NDI较单纯ACDF组改善更显著,差异有统计学意义(P<0.001)。所有病人末次随访时均植骨融合。结论 ACDF联合钩椎关节部分切除术治疗伴有钩椎关节增生、神经根管狭窄的神经根型颈椎病,与单纯ACDF相比,可以更快地缓解病人疼痛,提高病人生活质量,是一种安全、有效的治疗方法。

Objective To evaluate the clinical effect of anterior cervical decompression and fusion(ACDF) combined with partial resection of uncinate joint in the treatment of cervical spondylotic radiculopathy.Methods From September 2013 to July 2017, 76 cases(43 males and 33 females) of cervical spondyloticradiculopathy with an average age of 47.2 years were analyzed retrospectively. Forty-nine cases of ACDFcombined with partial resection of uncinate joint were included in the combined group, and 27 cases of ACDFalone were included in the ACDF group. The operation time, intraoperative blood loss, C2-C7 Cobb’s angle, VASand NDI before and after operation were analyzed. Results Seventy-six cases were followed up for 12-24 months(mean 18 months). One patient in the combined group had C5 nerve root palsy, and the rest had severeneurological impairment or other serious complications;one patient had hematoma in the wound after operation,and the hematoma was removed again. The average operative time in the combined group and ACDF group was(123.74±10.19) min and(108.00±10.50) min respectively, and the average blood loss during operation was(343.93±72.29) ml and(299.40±49.31) ml respectively. The VAS and NDI in both groups postoperation and atfinal follow-up were significantly improved as compared with those before operation(P<0.05). The Cobb angleof all patients increased significantly after operation, and no significant loss was found at the last follow-up.There was no significant difference in VAS between the two groups before operation, after operation and at thelast follow-up(P>0.05). However, the VAS and DNI in the combined group were better than those in the ACDFgroup postoperation. All patients showed bone graft fusion at the last follow-up. Conclusion Compared withsimple ACDF, ACDF combined with partial resection of uncinate joint with the advantages of quick relief ofpain, improved quality of life, is a safe and effective strategy for the treatment of cervical spondylotic radiculardisease with uncinate joint hyperplasia or nerve root canal stenosis.