改良颈前路椎体次全切除融合术与椎间盘切除融合术治疗四节段脊髓型颈椎病的对比研究

Comparative analysis of modified anterior cervical corpectomy and fusion and anterior cervical discectomy and fusion in the treatment of four-segment cervical spondylotic myelopathy

目的比较改良颈前路椎体次全切除融合术(ACCF)与颈前路椎间盘切除融合术(ACDF)治疗四节段脊髓型颈椎病(CSM)的临床效果。方法回顾性选取2013年1月至2019年12月中国科学院大学附属重庆仁济医院诊治的四节段CSM患者68例,按照治疗方式的不同将患者分为改良ACCF组(给予改良ACCF治疗,n=31)和ACDF组(给予ACDF治疗,n=37)。采用视觉模拟评分法(VAS)评估疼痛,采用日本骨科协会(JOA)评分、颈椎功能障碍指数量表(NDI)评分分别检测颈椎功能状态。比较2组患者的手术时间、术中出血量、疼痛、颈椎功能状态、颈椎生理曲度、颈椎Cobb角,以及并发症发生和骨性融合情况。结果改良ACCF组手术时间、术中出血量为(165.89±35.42) min、(735.58±159.26) mL,明显高于ACDF组[(131.59±31.22) min、(200.46±62.65) mL],差异均有统计学意义(P<0.05)。术后3、6、12个月2组VAS、NDI评分与术前比较均明显降低,JOA评分、颈椎生理曲度、颈椎Cobb角术前比较均明显升高,差异均有统计学意义(P<0.05),但术前、术后3、6、12个月2组VAS、JOA、NDI评分、颈椎生理曲度、颈椎Cobb角比较,差异均无统计学意义(P>0.05)。随访期间2组均无并发症发生,且骨性融合均为100%。结论改良ACCF和ACDF均能有效减轻四节段CSM患者的疼痛,改善颈椎生理曲度和颈椎矢状面生理前凸曲度,提高颈椎功能,并可增加植骨面,提高骨性融合,但ACDF手术时间和术中出血量相对更少。

Objective To compare the modified anterior cervical corpectomy and fusion(ACCF) and anterior cervical discectomy and fusionn(ACDF) in the treatment of four-segment cervical spondylotic myelopathy(CSM) effect. Methods A tatol of 68 patients with four-segment CSM diagnosed and treated in Chongqing Renji Hospital,University of Chinese Academy of Sciences from January 2013 to December 2019 were retrospective selected. According to the different treatment methods,the patients were divided into a modified ACCF group(given modified ACCF treatment),31 cases and ACDF group(ACDF treatment was given) In 37 cases. The visual analogue scale(VAS) was used to evaluate the pain,and the Japanese Orthopedic Association(JOA) score and the cervical spine dysfunction index(NDI) score were used to detect the cervical spine functional status. The operation time,intraoperative blood loss and pain of the two groups were compared. The functional status of the cervical spine,the physiological curvature of the cervical spine,the Cobb angle of the cervical spine,as well as the occurrence of complications and bony fusion. Results The operation time and intraoperative blood loss in the modified ACCF group were(165. 89 ± 35. 42) min and(735. 58± 159. 26) mL,which were significantly higher than those in the ACDF group[(131. 59 ± 31. 22) min,(200. 46 ± 62. 65) mL],and the differences were statistically significant(P<0.05). The VAS and NDI scores of the two groups were significantly reduced at 3 months,6 months,and12 months after the operation. The JOA score,cervical spine physiological curvature,and cervical Cobb angle were significantly increased before the operation,and the differences were statistically significant(P<0.05),but there was no difference in VAS,JOA,NDI score,cervical spine physiological curvature,and cervical Cobb angle before operation,3 months after operation,6 months after operation,and 12 months after operation. Statistical significance(P>0.05). During the follow-up period,there were no complications in both groups,and the bony fusion was100%. Conclusion Both the modified ACCF and ACDF can effectively reduce the pain of patients with four-segment CSM,improve the physiological curvature of the cervical spine and the physiological lordosis curvature of the cervical spine,improve the function of the cervical spine,increase the bone graft surface,and improve the bone fusion,but ACDF The operation time and intraoperative blood loss are relatively less.