显微镜下颈前路椎间盘切除植骨融合术治疗脊髓型颈椎病的临床效果

Clinical Observation on Treating Cervical Spondylotic Myelopathy in Microscope-Assisted Anterior Cervical Discectomy with Fusion

目的探讨显微镜下颈前路椎间盘切除植骨融合术(ACDF)治疗脊髓型颈椎病的临床效果,并与传统开放式ACDF进行比较。方法回顾性分析2015年1月至2017年10月于郑州大学第一附属医院诊治的78例脊髓型颈椎病患者的临床资料,根据手术方式分为显微镜下ACDF组(A组,42例)和传统开放式ACDF组(B组,36例)。记录两组患者手术时间、术中出血量、术后引流量、住院天数、视觉模拟(VAS)评分、日本骨科学会(JOA)评分及神经功能改善率并进行比较分析。结果两组手术时间和住院时间差异无统计学意义(均P>0.05),A组术中出血量和术后引流量少于B组,差异有统计学意义(均P<0.05)。两组术前、术后3个月、术后12个月JOA评分、VAS评分和神经功能改善率比较,差异无统计学意义(均P>0.05)。与术前相比,两组术后3、12个月JOA评分高于术前,VAS评分低于术前,差异有统计学意义(均P<0.05)。结论两种手术方式对脊髓型颈椎病均有良好疗效,术后患者脊髓神经功能恢复较为满意,但显微镜下ACDF治疗脊髓型颈椎病具有术中出血少,术后引流量少等优点。

Objective To investigate the clinical efficacy of microscope-assisted anterior cervical discectomy with fusion(ACDF) for treatment of cervical spondylotic myelopathy, and to compare with conventional ACDF.Methods A retrospective analysis of the clinical data of 78 patients with cervical spondylotic myelopathy diagnosed and treated in the First Affiliated Hospital of Zhengzhou University from January 2015 to October 2017. Patients were divided into microscope-assisted ACDF(Group A, 42) and conventional ACDF(Group B, 36). The operative time, intraoperative blood loss, postoperative drainage, length of stay in hospital, VAS score, JOA score and neurological improvement rate were compared between two groups.Results There was no statistically difference in the operative time and length of stay in hospital between two groups(all P>0.05). The intraoperative blood loss and postoperative drainage in Group A were less than Group B, the differences were statistical(all P<0.05). There were no statistically difference in the JOA score, VAS score and neurological improvement rate before operation, 3 months and 12 months after operation between two groups(all P>0.05). Compared with pre-operation, the JOA score was higher and the VAS score was lower than 3 months and 12 months after operation in two groups, the differences were statistical(all P<0.05).Conclusion Both surgical methods have good curative effect on cervical spondylotic myelopathy and the recovery of spinal cord function are good. Furthermore, microscope-assisted ACDF has the advantages of less intraoperative blood loss and postoperative drainage.