两种术式治疗多节段颈椎病的疗效比较

The efficacy comparison of two surgical methods for treatment of multiple segments cervical spondylosis effect

目的比较前路椎间盘减压融合术(ACDF)与前路椎体次全切除减压融合术(ACCF)对多节段颈椎病的临床疗效。方法将62例多节段颈椎病患者按照随机数字表法分为ACDF组和ACCF组,每组31例,记录术中出血量、术后引流量,采用颈椎活动度、颈椎曲度C值、颈椎前柱高度、JOA评分评价疗效。结果两组患者均随访24个月。术中出血量和术后引流量ACDF组均少于ACCF组(P<0.05)。术后3、6、12个月,颈椎活动度、颈椎曲度C值两组比较差异均无统计学意义(P>0.05);颈椎前柱高度ACDF组高于ACCF组(P<0.05)。术后12个月JOA评分ACDF组高于ACCF组(P<0.05)。结论ACDF和ACCF均能有效恢复脊柱形态,减轻脊髓神经压迫,最大限度恢复患者感觉、运动功能,但ACDF创伤更小、术后功能恢复更为理想。

Objective To compare clinical efficacy of anterior cervical disctomy and fusion(ACDF)with anterior cervical corpectomy and fusion(ACCF)for multilevel cervical spondylosis.Methods Sixty-two patients with multilevel cervical spondylosis were divided into ACDF group and ACCF group according to random number table,with 31 cases in each group.The intraoperative volume blood loss and postoperative drainage volume were observed,and cervical motion range,cervical curvature C value,cervical anterior column height and JOA score were used to evaluate the efficacy.Results All cases of two groups were followed up for 24 months.The volume of intraoperative blood loss and postoperative drainage in ACDF group were significantly less than those of ACCF group(P<0.05).At 3,6,12 months postoperation,the motion range of cervical vertebrae and C values of cervical curvature in the two groups had no differences(P>0.05).The cervical anterior column height in the ACDF group was higher than that of ACCF group(P<0.05).JOA scores of ACDF group was higher than that of ACCF group at postoperative 12 months(P<0.05).Conclusions ACDF and ACCF both can effectively restore spinal shape,reduce spinal cord nerve compression,furthest restore the patients′feeling and movement function,and ACDF is less invasive,postoperative functional recovery is more ideal.