颈前路椎间盘切除椎间植骨融合术对35岁以下神经根型颈椎病患者的近远期疗效研究

Short-term and long-term results of cervical anterior cervical discectomy and interbody fusion for cervical spondylosis patients under 35 years old

目的研究颈前路椎间盘切除椎间植骨融合术对35岁以下神经根型颈椎病(CSR)患者的近远期疗效。方法纳入我院收治的CSR患者40例,所有患者均接受颈前路椎间盘切除椎间植骨融合术,并对患者进行至少1年的随访。对40例患者的随访结果进行分析,分别于治疗前,治疗后3、6、12个月和末次随访对患者Cobb′角和弓深变化进行比较,对治疗前,治疗后3、6、12个月和末次随访的患者疼痛程度和脊髓神经功能进行评分。结果40例CSR患者均成功进行颈前路椎间盘切除椎间植骨融合术,术中平均失血量(37±17)mL。40例患者术后均未发生明显并发症,且在进行术后随访半年均已恢复正常的工作、学习和生活。对2组患者治疗后均进行颈椎X线片检查,未出现内固定失效、松动、折断等现象的发生。与治疗前相比,治疗后3、6、12个月和末次随访患者的Cobb′角和弓深均明显增加(P<0.05)。治疗后不同时间Cobb′角和弓深的比较差异无统计学意义(P>0.05)。与治疗前相比,治疗后3、6、12个月和末次随访患者的视觉模拟评分法(VAS)评分明显降低(P<0.05),月本模拟评分法(JOA)评分明显增加(P<0.05)。治疗后不同时间患者的VAS和JOA评分比较,差异无统计学意义(P>0.05)。结论颈前路椎间盘切除椎间植骨融合术治疗35岁以下的CSR患者,具有术中创伤小,出血量低,对神经根减压效果良好等优点,能够有效恢复CSR患者的颈椎生理弧度,增强颈椎的稳定性,疗效佳且稳定,能够有效降低术后患者的疼痛程度以及促进神经功能的改善,值得在临床中推广应用。

Objective To study the short-term and long-term effects of anterior cervical discectomy and interbody fusion for cervical spondylosis patients under 35 years old.Methods Forty patients with CSR admitted to our hospital were enrolled.All patients underwent anterior cervical discectomy and interbody fusion.The patients were followed up for at least 1 year.The follow-up results of 40 patients were analyzed.The changes of Cobb'angle and bow depth were compared before treatment,3 months,6 months and 12 months after treatment and the last follow-up.The degree of pain and spinal cord function were scored in patients before treatment,3,6 and 12 months after treatment,and at the last follow-up.Results Forty patients with CSR were successfully treated with anterior cervical intervertebral discectomy and interbody fusion.The blood loss during operation was(37±17)mL.None of the 40 patients had significant complications after surgery,and they had returned to normal work,study and life during the six months of follow-up.Cervical X-ray examination was performed on both groups of patients after treatment,and no internal fixation failure,loosening,and breakage occurred.Cobb′s angle and bow depth were significantly increased in the 3 months,6 months,12 months,and the last follow-up after treatment(P<0.05).There was no significant difference in Cobb'angle and bow depth at different time after treatment(P>0.05).Compared with before treatment,the VAS scores of patients at 3 months,6 months,12 months and the last follow-up were significantly lower(P<0.05),respectively and the JOA scores were significantly increased(P<0.05).There was no significant difference in VAS and JOA scores between patients at different time after treatment(P>0.05).Conclusion Anterior cervical intervertebral discectomy and interbody fusion for the treatment of CSR patients under 35 years old have the advantages of small intraoperative trauma,low blood loss and good decompression of nerve roots.It can effectively restore the cervical curvature of CSR patients and enhance the stability of the cervical vertebrae.The curative effect is good and stable.It can effectively reduce the pain level of postoperative patients and promote the improvement of nerve function,which is worthy of popularization in clinical practice.