探讨前路ACDF与后路PDDL术对颈椎疾患非典型症状的缓解及可能机制

Relief of atypical symptoms in patients with cervical spondylosis by anterior ACDF surgery and posterior double open door laminoplasty and its possible mechanism

目的探讨前路颈椎间盘切除椎体间融合术(anterior cervical discectomy and interbody fusion,ACDF)和后路双开门椎板成形术(posterior double open door laminoplasty,PDDL)对颈椎病患者非典型症状的疗效。方法纳入2016年8月~2018年8月收治的颈椎病患者93例,所有患者均存在颈肩痛和上肢放射痛、麻木、精细运动能力减退等颈椎病典型症状;同时,伴有至少以下任一项非典型症状:包括视力模糊、头痛、恶心、心悸、耳鸣、眩晕、记忆力减退和腹部不适等。颈髓受压1~2个节段的51例患者酌情选择ACDF手术治疗(ACDF组),颈髓受压≥3个节段的42例患者则接受了PDDL手术(PDDL组)。对两组患者的一般资料和术前非典型症状构成情况进行比较;术后2年时,门诊观察两组患者的非典型症状改善情况,并作分组对比。结果两组患者的一般资料和术前非典型症状构成情况进行比较,组间差异均无统计学意义(P>0.05);术后2年随访时,两组的非典型症状均获得显著缓解,但两组的缓解程度比较,差异无统计学意义(P>0.05)。结论ACDF与PDDL手术对颈椎病患者的非典型症状均可起到缓解作用;颈椎病非典型症状可能不是源于后纵韧带交感神经纤维所致。

Objective To evaluate the efficacy of anterior cervical discectomy and interbody fusion(ACDF)and posterior double open door laminoplasty(PDDL)in the treatment of atypical symptoms of cervical spondylosis.Methods Ninety-three patients with cervical spondylosis admitted from August 2016 to August 2018 were enrolled in this study.All patients had typical symptoms of cervical spondylosis,such as neck and shoulder pain,upper limb radiation pain,numbness,decreased fine motor ability,at least one of the following atypical symptoms:blurred vision,headache,nausea,palpitation,tinnitus,vertigo,memory loss and abdominal discomfort,etc.Fifty-one patients with 1-2 segments of cervical spinal cord compression were treated with ACDF operation(ACDF group),and 42 patients with cervical spinal cord compression≥3 segments underwent PDDL operation(PDDL group).The general data and the composition of atypical symptoms of the two groups were compared,and the improvement of atypical symptoms of the two groups were observed and compared at 2 years after operation.Results The general information and the composition of preoperative atypical symptoms between the two groups had no statistically significant differences(P>0.05).At 2 years after operation,the atypical symptoms of the two groups were significantly relieved,but there was no statistically significant difference in the degree of remission between the two groups(P>0.05).Conclusion Both ACDF and PDDL can significantly relieve the atypical symptoms of cervical spondylosis,and the atypical symptoms of cervical spondylosis may not be caused by the sympathetic network of the posterior longitudinal ligament.