颈椎前路Hybrid术对脊髓型颈椎病患者颈椎矢状位参数及颈椎功能恢复的影响

Effect of cervical anterior Hybrid surgery on cervical spine sagittal parameters and the recovery of cervical spine function in patients with cervical spondylotic myelopathy

目的:探讨颈椎前路杂交(Hybrid)术对脊髓型颈椎病患者颈椎矢状位参数及颈椎功能恢复的影响。方法:选取72例经手术治疗的脊髓型颈椎病患者,根据手术方式不同分为常规组(40例)和试验组(32例)。常规组采用Smith-Robinson经椎间隙减压融合术(ACDF)治疗,试验组采用ACDF联合颈椎人工间盘置换(cADR)的Hybrid术治疗。比较两组患者围手术期指标、手术前后影像学指标、日本骨科协会(JOA)评分和颈痛视觉模拟量表(VAS)评分以及术后并发症发生情况。结果:两组手术时间、术中出血量、住院时间、住院费用比较无统计学差异(P>0.05)。两组术后3、6、12个月的Cobb角高于治疗前,T 1倾斜角、颈椎整体活动度(ROM)低于治疗前,且试验组术后3、6个月的ROM低于常规组(P<0.05)。两组术后12个月颈部VAS评分低于术前,JOA评分高于术前,且试验组术后12个月JOA评分高于常规组(P<0.05)。两组术后并发症发生率比较无统计学差异(P>0.05)。结论:颈椎前路Hybrid术可以改善脊髓型颈椎病患者颈椎矢状位参数,加快患者术后颈椎功能的恢复。

Objective:To explore the effect of cervical anterior Hybrid surgery on cervical spine sagittal parameters and the recovery of cervical spine function in patients with cervical spondylotic myelopathy(CSM).Methods:Seventy two patients with cervical spondylotic myelopathy were selected and divided into routine group(40 cases)and experimental group(32 cases)according to different surgical methods.The routine group was treated with Smith-Robinson anterior cervical discectomy and fusion(ACDF),while the experimental group was treated with ACDF combined with Hybrid of cervical artificial disc replacement(cADR).The perioperative indexes,imaging parameters,scores of Japanese Orthopaedic Association(JOA)and Visual Analogue Scale(VAS)of neck pain before and after surgery,and postoperative complications were compared between two groups.Results:There were no differences in perioperative indexes such as operation time,intraoperative blood loss,hospitalization time and hospitalization cost between two groups(P>0.05).At 3,6 and 12 months after surgery,Cobb angle in both groups was higher than that before treatment,while T 1 tilted angle and cervical range of motion(ROM)were lower than those before treatment.At 3 and 6 months after surgery,ROM of experimental group was lower than that of routine group(P<0.05).At 12 months after surgery,VAS scores of neck pain in both groups were significantly lower than those before surgery,while JOA scores were higher than those before surgery.At 12 months after surgery,JOA score in experimental group was higher than that in routine group(P<0.05).There was no difference in incidence of postoperative complications between two groups(P>0.05).Conclusion:Cervical anterior Hybrid surgery can improve cervical spine sagittal parameters of CSM patients,and accelerate recovery of postoperative cervical spine function.