颈椎前路Hybrid术治疗颈椎退行性疾病

Clinical observation on the treatment of cervical degenerative diseases with Hybrid surgery

目的:探讨颈椎前路Hybrid术治疗颈椎退行性疾病的临床疗效并观察其术后1年影像学上间盘置换节段异位骨化的发生率。方法:对2015年1月至2018年4月接受颈椎前路Hybrid术符合纳入和排除标准并获得完整临床随访资料的35例患者进行回顾性分析,其中24例获得完整影像学随访资料,男15例,女20例,年龄39~70(55.57±7.73)岁,手术出血量20~100(40.29±18.39)ml,住院时间4~28(11.03±4.63)d,随访时间(12.97±1.36)个月。采用田中靖久颈椎病症状量表(Tanaka Yasushi Cervical Spondylitis Symptom Scale 20 Score,YT20)及日本矫形骨科协会(Japanese Orthopaedic Association,JOA)评分进行临床疗效评价,术后1年通过X线依据McAfee标准评价Hybrid术后异位骨化发生的情况,并对是否发生异位骨化患者进行分组,比较其临床疗效。结果:末次随访时平均YT20评分和JOA评分较术前明显升高(P<0.05),JOA平均改善率为(70.66±0.44)%。24个节段中10个节段出现异位骨化,发生率为41.70%,其中Ⅰ级为29.20%,Ⅱ级为12.50%。异位骨化发生和未发生患者的临床疗效比较:术前、术后JOA评分差异无统计学意义(P>0.05);术前YT20评分差异无统计学意义(P>0.05),术后异位骨化发生患者YT20评分明显低于未发生患者。结论:Hybrid术近期临床疗效满意,异位骨化发生的原因仍需要进一步探索。

Objective:To investigate the clinical effect of anterior cervical Hybrid surgery in the treatment of cervical degenerative diseases(CDD)and observe the incidence of heterotopic ossification of disc replacement segment at 1 year after surgery.Methods:From January 2015 to April 2018,35 patients who received anterior cervical hybrid surgery met the inclusion and exclusion criteria and the complete clinical follow-up data were analyzed retrospectively.Complete imaging follow-up data were obtained from 24 patients.There were 15 males and 20 females,aged from 39 to 70(55.57±7.73)years old.The amount of bleeding was for 20 to 100(40.29±18.39)ml,and the hospital stay was for 4 to 28(11.03±4.63)days,and the follow-up time was(12.97±1.36)months.Clinical outcomes were assessed by the Tanaka Yasushi cervical spondylitis symptom scale 20 score(YT20),and Japanese Orthopaedic Association(JOA)score.The occurrence of heterotopic ossification after Hybrid surgery was evaluated by X-ray according to McAfee standard one year after operation.Patients with or without heterotopic ossification were divided into two groups and their clinical effects were compared.Results:At the final follow-up,the mean YT20 score and JOA score were significantly higher than those before operation(P<0.05),and the average improvement rate of JOA was(70.66±0.44)%.One year after operation,the heterotopic ossification occurred in 10 of 24 segments,with incidence of 41.70%(10/24),including 29.20%in gradeⅠand 12.50%in gradeⅡ.The results of clinical efficacy comparison between patients with and without heterotopic ossification were as follows:there was no significant difference in JOA score before and after operation(P>0.05);there was no significant difference in YT20 score before operation(P>0.05),and YT20 score in patients with heterotopic ossification was significantly lower than that in patients without heterotopic ossification(P<0.05).Conclusion:The short-term clinical effect of Hybrid surgery is satisfactory for cervical degenerative diseases,and the cause of heterotopic ossification still needs to be further explored.