颈椎前路Hybrid手术治疗颈椎病的疗效观察

The clinical effects of cervical anterior Hybrid surgery for cervical spondylosis

目的:观察颈椎前路Hybrid手术(颈椎前路减压椎间融合术+颈椎全椎间盘置换术)治疗颈椎病的临床疗效。方法:收集2017年7月~2019年12月接受颈椎前路Hybrid手术的颈椎病患者的临床资料,符合纳入和排除标准并获得临床随访资料者共56例,其中获得完整影像学随访资料者40例。56例患者中神经根型颈椎病36例,混合型颈椎病12例,脊髓型颈椎病7例,交感型颈椎病1例;双节段病变39例,三节段病变17例;男25例,女31例;年龄34~72(54.23±8.72)岁。分别在术前、末次随访时记录患者田中靖久颈椎病症状量表评分(Tanaka Yasushi cervical spondylitis symptom scale 20 score,YT20评分)及颈椎JOA评分;在X线片上测量患者C2-7 Cobb角、手术节段脊柱功能单位Cobb角、C2-7矢状面轴向距离和T1倾斜角;依据Goffin标准对Hybrid手术后邻近节段退变(adjacent segment degeneration,ASD)进行分级。结果:56例患者的手术时间为88~360min(175.25±55.97min),术中出血量10~20ml(14.91±4.21ml),引流量5~80ml(17.92±17.13ml),住院时间4~29d(11.20±5.70d),随访时间6~29个月(11.59±6.11个月)。1例患者术后2d于切口附近出现血肿。末次随访时YT20评分和JOA评分均较术前显著好转(9.02±3.50 vs 17.18±3.24,P<0.05;14.38±1.93 vs 16.40±1.12,P<0.05),JOA评分改善率平均为81.12%(0%~100%);C2-7 Cobb角(1.59°±6.76°vs 5.60°±8.32°,P<0.05)、手术节段Cobb角(8.64°±10.68°vs 11.91°±10.94°,P<0.05)均较术前明显改善。末次随访时C2-7矢状面轴向距离(17.63±8.54mm vs 17.79±10.67mm,P>0.05)、T1倾斜角(23.32°±7.25°vs 24.42°±7.10°,P>0.05)较术前无统计学差异。末次随访时,40个上邻近节段中ASD发生率为20.00%,其中退变分级较术前增加1级的为12.50%,较术前增加2级的为7.50%;37个下邻近节段中ASD发生率为16.22%,其中退变分级较术前增加1级的为8.11%,较术前增加2级的为8.11%,均无较术前增加3级者。上邻近节段发生退变与未发生退变患者比较,术前和末次随访时JOA评分、YT20评分均无统计学差异(P>0.05);下邻近节段发生退变与未发生退变患者比较,术前及末次随访时JOA评分、YT20评分均无统计学差异(P>0.05)。手术节段上节段置换35例、融合5例,下节段置换3例、融合37例;手术节段上节段融合的ASD发生率(40.00%)与置换的ASD发生率(17.14%)比较无统计学差异(P>0.05),下节段融合的ASD发生率(20.00%)与置换的ASD发生率(0.00%)比较无统计学差异(P>0.05)。结论:颈椎前路Hybrid手术后近期临床症状明显改善,颈椎C2-7和手术节段曲度明显增加;但ASD发生率相对较高,手术节段置换或融合对ASD的影响不大,仍需进一步观察ASD的影响因素。

Objectives:To evaluate the clinical effects of the Hybrid surgery.Methods:Inpatients who underwent Hybrid surgery from July 2017 to December 2019 were retrospectively reviewed.56 patients(25/31 males/females)aged 54.23±8.72(34-72)years were enrolled,of which 40 cases underwent X-Ray.The cervical radiculopathy was in 36 cases,mixed cervical spondylosis in 12 cases,cervical spondylotic myelopathy in 7 cases,and sympathetic cervical spondylosis in 1 case.There were 39 cases with two-level lesion and 17 cases with three-level lesion.Clinical outcomes were assessed by the Tanaka Yasushi cervical spondylitis symptom scale 20 score(YT20 score),Japanese Orthopedic Association scale(JOA score).The changes of C2-7 Cobb angle,functional spinal unit(FSU)Cobb angle,C2-7 sagittal vertical axis(C2-7 SVA)and T1 slope(T1 S)were observed at pre-operation and the final follow-up.Adjacent segment degeneration(ASD)evolution was evaluated by Goffin′s criteria on cervical X-ray film.Results:Of all the 56 patients,the operation time was 88-360 min(175.25±55.97 min),intra-operative blood loss was 10-20 ml(14.91±4.21 ml),drainage volume was 5-80 ml(17.92±17.13 ml),length of stay was 4-29 d(11.20±5.70 d),and follow-up period was 6-29(11.59±6.11)months.Neck hematoma was shown in 1 case at 2 d postoperatively.Compared with pre-operation,the data showed better YT20(9.02±3.50 vs 17.18±3.24,P<0.05)and JOA score(14.38±1.93 vs 16.40±1.12,P<0.05)at the final follow-up,and the average improvement rate of JOA score was 81.12%(0%-100%).Compared with pre-operation,there were significant differences of C2-7 Cobb angle(1.59°±6.76°vs 5.60°±8.32°,P<0.05),FSU Cobb angle(8.64°±10.68°vs 11.91°±10.94°,P<0.05)at final follow-up.There were no significant differences of C2-7 SVA(17.63±8.54 mm vs 17.79±10.67 mm,P>0.05),T1 S(23.32°±7.25°vs 24.42°±7.10°,P>0.05)between pre-operation and final follow-up.ASD rate after Hybrid surgery:the ASD rate of superior level on X-ray film was 20.00%,and 1 and 2 grade was 12.50%and 7.50%respectively;the ASD rate of inferior level was 16.22%,and 1 and 2 grade was 8.11%and 8.11%respectively.There were no significant differences between ASD and non-ASD in JOA score and YT20 score(P>0.05),and between the ASD rate of fusion segment located cephalad(40.00%)and replacement segment located cephalad(17.14%)(P>0.05);there was no significant difference of the ASD rate of fusion segment located caudal(20.00%)and replacement segment located caudal(0.00%)(P>0.05).Conclusions:Compared to pre-operation,the data showed better symptoms improved,C2-7 Cobb and FSU Cobb after 1 year of Hybrid surgery.However,the ASD rate was relatively high.The effect of surgical segment replacement or fusion on ASD was not significant,and the influencing factors of ASD after hybrid surgery need to be further observed.