ACDF与后路椎板成形术治疗双节段局限性后纵韧带骨化性颈椎病的临床效果比较

Comparative Study on the Clinical Effect of Anterior Cervical Discectomy and Fusion and Posterior Laminoplasty for the Treatment of Localized Ossifying Cervical Spondylopathy of the Posterior Longitudinal Ligament

目的:比较颈椎前路椎间盘摘除融合术(ACDF)和后路椎板成形术治疗双节段局限性后纵韧带骨化症(OPLL)导致的脊髓型颈椎病的临床和影像学结果。方法:回顾性分析2013年5月—2018年5月于我院行手术治疗的双节段局限性OPLL患者113例。根据术式不同将患者分为椎板成形组57例和ACDF组56例。测量术前、术后及末次随访的C_(2)~C_(7) Cobb角、T_(1)倾斜角、C_(2)~C_(7) SVA、ROM、OR、脊髓可用空间;评估两组术前、术后即刻、末次随访的JOA、VAS、NDI评分;记录手术时间、术中出血量、手术并发症。结果:ACDF组的手术时间、术中出血量和住院时间均低于椎板成形术组(P<0.05)。末次随访时NDI、JOA和VAS评分均较术前明显改善(P<0.001)。并发症方面,ACDF并发症发生事件明显低于椎板成形组,差异有统计学意义(P<0.05)。两组的影像学指标末次随访较术前均有显著改善(P<0.05)。末次随访时椎板成形术组的活动度(ROM)优于ACDF组,但两组间差异无统计学意义(P>0.05)。结论:ACDF和椎板成形术治疗双节段局限性OPLL均显示了满意的临床和影像学结果。然而,ACDF组的手术时间、出血量、住院时间和并发症较少。

Objective:To compare the clinical and radiological results of anterior cervical discectomy and fusion(ACDF)and posterior laminoplasty in the treatment of cervical spondylotic myelopathy caused by two-level localized ossification of the posterior longitudinal ligament(OPLL).Methods:A total of 113 patients with two-level localized OPLL who underwent surgery in our hospital from May 2013 to May 2018 were retrospectively analyzed and included in this study.According to different operations,the patients were divided into two groups:57 in the laminoplasty group and 56 in the ACDF group.C_(2)~C_(7)Cobb angle,T_(1)inclination angle,C_(2)~C_(7)SVA,ROM,OR,spinal cord usable space were measured before surgery,after surgery,and during follow-up;JOA,VAS,and NDI scores were assessed before surgery,immediately after surgery,and during follow-up in both groups;operation time,intraoperative blood loss,and surgical complications were recorded.Results:The operation time,intraoperative blood loss and hospital stay in ACDF group were lower than those in laminoplasty group(P<0.05).NDI,JOA,and VAS scores were significantly improved at follow-up(P<0.001).In terms of complications,the incidence of complications in ACDF group was significantly lower than that in laminoplasty group,and the difference had statistical significance(P<0.05).The imaging parameters of the two groups were significantly improved at follow-up(P<0.05).The range of motion(ROM)of laminoplasty group was better than that of ACDF group at follow-up,but there was no significant difference between the two groups(P>0.05).Conclusion:Both ACDF and laminoplasty showed satisfactory clinical and radiological results in the treatment of two-level localized OPLL.However,the operation time,blood loss,hospital stay,and complications were less in the ACDF group.